Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21TechnologyAPPLICATION OF DATA MINING TECHNIQUES TO PROBLEMS IN FUND RAISING
English0110Adrian UdenzeEnglishData mining in fund raising applications have been shown to significantly increase funds raised by charity organisations. This research investigates the accuracy of statistical classification techniques when applied to various prediction problems in fund raising. The results show that increased accuracy of predictions can be achieved by using actions taken by fund raisers as attributes as well as donor profiles. Where classification techniques fail, data mining results are shown to be useful for formulating and solving optimisation problems which are solved to provide the best course of actions for maximum return on investment.
EnglishData mining, Fund raisingINTRODUCTION The total amount of money given in charity for the year 2012 in the United Kingdom was £9.2 billion according to the BBC [1]. With such a vast potential for attracting funds, charity organisations are increasingly making use of state of the art techniques in data mining to identify potential donors, increase donation amounts and maximise return on investments. In particular, fund raisers would like to be able to identify donors from a list and also, correctly predict how much a donor is likely to give. If fund raisers can correctly predict how much an individual will donate then they can ask for the optimal amount of money from each donor and also ensure that the right amount of resources are expended in acquiring those funds. In [2], the author uses donor profiles consisting of a number of donor related attributes to construct Decision Trees [3] and Neural Networks [4] for predicting donors and non donors. The author observes mixed results with better results for predicting non donors than for donors. The work presented here builds on that research by providing a more in-depth investigation into the suitability of statistical classification techniques common in data mining for fund raising applications. In particular, the contributions of this work are as follows 1.) statistical classification techniques are shown to be suitable for predicting with reasonable certainty whether or not an individual will make a charitable donation depending on the profile attributes used. 2.) statistical classification techniques are shown however to have limitations on what can be predicted including which charity an individual will donate to and how much an individual will give. 3.) It is shown that whereas in [2] the author uses only donor attributes, actions taken by fund raisers have a correlation to amounts donated and can be used to improve accuracy of predictions. As far as the author is aware this is the first time the actions of the fund raiser are being considered as an attribute for classifying donors. 4.) Given that the aim of the data mining exercise within a charity organisation is to maximise funds by asking for the optimal amounts from donors and using minimal resources in so doing, in the absence of reliable prediction from conventional data mining classification techniques, the author shows that return on investment can still be improved on by formulating and solving an optimisation problem the result of which is a policy for carrying out actions that maximise return on investment. LITERATURE REVIEW Data mining has been shown to help organisations increase return on investment for given fundraising campaigns. In [5] the author shows results of a number of fundraising campaigns with data mining and without. The results show an average of 50% increase in amount raised per dollar spent for campaigns with statistical analysis. In [6], the authors state that data mining can improve existing models by finding additional important variables, identifying interaction terms and detect ing nonlinear relationships. Data mining is also useful in making sure that a fund raising officer asks for the right amount of money from a given prospect [7]. In [2] the author attempts to predict prospect donor amounts based on data collected on previous campaigns using decision trees and neural networks. The author concludes that neural networks give a slightly more accurate prediction however he observes that increased accuracy of donors may be obtained by collecting more data. Decision trees [3] are a common approach to discovering logical patterns within data sets. A tree is built using Binary Recursive Partitioning based on an iterative process of splitting a set of pre-classified test data into homogeneous segments and then splitting each segment or branch of the tree into more segments. The end result is a model of the test data that classifies each observation which can then be used for the classification of other records. Neural networks have been used extensively for data mining in various fields of science ranging from medical diagnostics, to online real time financial systems [4]. Their ability to model relationships in data make them useful for classifying tasks as well as predicting future events. Supervised learning usually takes the form of adjusting weights in a neuron such that the difference between network outputs when compared to desired outputs are minimised at which stage the network is fully trained and can be used for predicting or classifying tasks. In unsupervised learning, weights are adjusted to match world events in real time. Operations research provides a decision making mechanism for problems of limited resources and have been used extensively in industry for optimising return on investment [8]. Numerous optimisation problems including scheduling tasks, optimal route finding and budgeting have been solved using operations research techniques. The work in this paper builds on the work in [2] and [6]. Results of classification of prospects using decision trees and neural networks are presented using donor profiles as done in [2]. Furthermore, this work shows that increased accuracy of prediction can be achieved using a new set of attributes namely, actions taken by fund raisers. The authors also show that by using the results of the classification exercise to formulate and solve an optimisation problem, return on investment can be maximised. METHODOLOGY The data set used for experiments was acquired from an international human rights organisation and consisted of details of past marketing campaigns. Records included profiles of donors as well as non donors. The data set consisted of 10,000 entries initially. The data was cleaned and records with incomplete or inaccurate data were deleted. A sample of the records used is shown in Table 1 below. The aim of this research was to model the data set such that the model could be used to predict as accurately as possible the following: 1. Charity donor and non donor. To predict from the data set which individual was likely to make a charitable contribution two classification models were used. First decision trees were constructed using the Tree package in R available from the cran.r project website at the time of writing [9] and then neural networks using the nnet package also available from the cran.r project website, for different numbers of variables. 70% of 1000 records of donors and 1000 records of non donors were used for training, the remaining 30% was set aside for testing. The resulting models from training were then used on the test data set for predictions; results are presented in the results section. 2. Donate to a given charity. Neural networks were constructed with 70% of 500 records each for four charities and 30% set aside for testing. The number of records used for training was limited by the number of records available. Test results are presented in the results section. 3. How much will a donor contribute to a given charity. The donor amount field was discretized and placed in 7 bins which were used as classes namely {0, 1-1000, 1000-5000, 5000-10000, 10000-50000, 50000-100000, >100000}. Thus, the aim was to predict in which one of the 7 bins or classes a prospect belonged. To ensure there was no bias in the results, equal numbers of records for each class was used in the data set. After selecting, transforming and cleaning the data the number of entries was reduced to 7000 i.e. 1000 for each class. Finally the data set was split into two, 70% for training and 30% for testing, results are presented in the results section. Next, actions taken by fundraisers were used as variables in addition to the donor variables. For a given campaign, several actions are available to the fund raisers e.g. telephone calling, emailing, organising events, carrying out an advertising campaign on radio or television. In addition, several of these actions may be undertaken e.g. send an email and then telephone. Results of the enhanced models are presented in the results section. 4. Finally, the results of the data mining exercise were used to formulate an optimisation problem which was then solved as a Linear Programming problem using the R package linear programming solver, available from the cran.r project website at the time of printing [9]. E.g. for a given marketing campaign, the fundraisers have a set of four actions {Telephone, Email, Organise an event, Email and Telephone, Telephone and Organise and Event}. Each action has an associated return on investment R and actions A have constraints C placed on them. The optimisation problem can then be formulated as Maximise R1 A1 + R2 A2 + R3 A3 + ... RnAn (1) Such that A1 + A2 + A3 ... 0, X2 > 0, x3 > 0, x4 > 0 Solving using linear programming, the result is obtained as 0x1 102.27x2 0x3 1.79x4. Objective = £2106.82 Translated as: Make 102.27 phone calls and organise 1.79 events and the campaign should realise £2106.82! This solution provides the best course of action to raise the most money. Note however that the campaign team cannot organise 1.79 events nor can they make 102.27 phone calls i.e. either 102 phone calls or 103 phone calls. To overcome this the solver is forced to return only integer values which provides a new result of 0x1 0x2 0x3 2x4 Objective = £1800. Translated as: Organise 2 events which will raise £1800! Results observed from test data using data mining as well as solving a formulated optimisation problem results in an increase of between 15% and 18% on return on investment compared to data mining alone. CONCLUSIONS Data mining for fund raising experiments using two classification techniques, decision trees and neural networks have shown to be effective in identifying potential donors but less so in identifying which charity an donor is likely to donate to and how much. The addition of actions taken by fund raisers to data mining variables increased accuracy of predictions compared to variables consisting of only donor profiles. The link between actions taken by fund raisers and donor amounts was explored further by formulating and solving a constrained decision prob- lem the result of which is a course of action that yields maximum return on investment. Future work will be on investigating modelling techniques for sparsely correlated data and using the models to formulate and solve constrained decision making problems in fund raising. ACKNOWLEDGEMENTS The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to the authors / editors / publishers of all those articles, journals and books where the literature for this article has been reviewed and discussed. The author also acknowledges the contributions of Amnesty International UK.
Englishhttp://ijcrr.com/abstract.php?article_id=705http://ijcrr.com/article_html.php?did=7051. BBC News. (2012) ‘Charity donations down 20%, UK Giving Report 2012, ‘www.bbc.co.uk/news/uk-20304267’ Accessed Nov 2014.
2. Heiat, N. (2011) ‘Data Mining Applications in Fund Raising’, in World Journal of Social Sciences, Vol. 1. No. 4. 14- 22.
3. Greenberg D, Pardo B., Hariharan K. And Gerber E. (2013) ‘Crowd funding support tools: predicting success and failure’, in Proceedings of Chi EA 13 Extended Abstracts on Human Donors Factors in Computing Systems, pages 1815- 1820, ACM New York.
4. Jain N. and Srivastava V. (2013) ‘Data Mining techniques: A survey paper’, in International Journal of Engineering and Technology’ Vol2. Issue 11.
5. Wylie, P. (2008) ‘Baseball, Fundraising, and the 80/20 Rule: Studies in Data Mining’ Washington, DC : CASE (Council for Advancement and Support of Education).
6. Devale, A. B. and Kulkarni, R. V. (2012) ‘Applications of data mining techniques in life insurance’, in International Journal of Data Mining and Knowledge Management Process (IJDKP) Vol.2, No.4: 31-40.
7. Birkholz, J. (2008) ‘Fundraising Analytics: Using Data to Guide Strategy’ 1st edition, John Wiley and Sons, Inc.
8. Xing Y. Li L. and Bi. Z. (2013) ‘Operations research in service industries: A comprehensive review’, in Systems Research and Behavioural Science, Special Issue: Systems Science in Industrial Sectors, Vol 30, Issue 3, pages 300 – 353.
9. Cran.r project (2014), ‘Linear Programming package’ in www.cran.r-project.org/web/packages, Accessed Nov 2014.
specific charity
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareAutopsy Study of Brought Dead Cases in Jaipur, Rajasthan
English1114N. L. DisaniaEnglish Akhilesh K. PathakEnglish R. K. PuniaEnglishBackground: Most of the medico-legal cases are dealt by the government hospitals in India. Incidences of brought dead cases are higher in Sawai Man Singh Hospital, Jaipur, due to high referral rate from all areas of Rajasthan as well as from the nearby border. In all cases, who are found dead clinically on arrival examining doctor is not able to opine cause of death and hence the dead body has to be shifted for autopsy examination. Aims and Objective: There is very little information available regarding the cases of brought dead. The present study was undertaken to know the epidemiological aspects, patterns and other significant medico-legal issues regarding the brought dead cases. Method: This autopsy based retrospective study was conducted in the department of Forensic Medicine, S.M.S. Medical College, Jaipur (Rajasthan). Around 3123 autopsies were conducted during the one year period of 2012 and out of them 990
(31.70%) cases, which were brought dead to the casualty department were analyzed during this study irrespective of age, gender, religion and area of domicile. The results: In the present study, we found that the majority of the victims who were brought dead to us were Hindu males, in their 3rd and 4th decade of life that died accidentally in road traffic accident. Conclusion: Our study reveals that the cases of brought dead were included more incidences of unnatural deaths rather than the natural deaths, which are having less medico-legal significance and more suffering to relatives of the deceased as well as the investigating agencies.
EnglishDeath, Brought dead and Cause of deathINTRODUCTION
Brought dead or received dead (brought in dead) is a condition where the patient is found dead clinically by the examining medical person. In these cases the patient was alive before some time, but on arrival in hospital no signs of life are present. Determination of death and its various medico-legal issues are discussed by various authors. (1, 2, 3, 4) Now it is essential that the cause of death and the identity of the deceased be properly determined before lawful disposal of the dead body and it also helps to collect data regarding death. From 1 April 1969, under the Registration of Births and Deaths Act, the registration of births and deaths is now compulsory throughout India. For this purpose, whenever necessary by law, it is obligatory for a medical practitioner who last attended the deceased person, to issue a death certificate, after inspecting the body and satisfying himself of the person’s death, stating the underlying cause of death- that is the morbid condition or disease process, or abnormality leading directly or indirectly to death. (5) The incidences of brought dead cases are increasing day by day in the casualty department of S.M.S. Hospital, Jaipur because of high referral rates from the peripheral health centers and involvement of fatal natural and unnatural events. In most of the cases of brought dead, the patients are either referred from a lower health center for further management or brought by the police or relatives in the presumption of life or to confirm the death. There is very little information available regarding the cases of brought dead as only few studies has been conducted before this, and hence the present study was undertaken to know the epidemiological aspects, patterns and other significant medico-legal issues regarding the brought dead cases.
Material and Methods:
The present retrospective study was conducted in the department of Forensic Medicine, S.M.S. Hospital, Jaipur in which is a tertiary health center of Rajasthan. Here the cases are referred from almost all areas of Rajasthan as well as from the border areas of nearby state like Uttar Pradesh and Haryana. Around 3123 autopsies were conducted during the one year period of 2012 and out of them 990 (31.70%) cases, which were brought dead to the casualty department were selected for the present study. All cases who were found dead clinically on arrival in casualty irrespective of age, gender, religion and area of domicile were taken into consideration and detailed and complete post mortem examination was conducted to know the exact cause of death. Information regarding the scene of crime and history was collected from the relatives and concerning police person and the detailed autopsy report findings were taken into consideration to conclude the manner of death whether it was suicidal, accidental or homicidal in nature. Finally the data were collected and analyzed at medical college, Baroda, Gujarat and compared with data of other authors.
Results
Out of total 3123 autopsies, 990 cases (31.70%), which were brought dead to the casualty department, were selected for the present study. The maximum incidences of brought dead cases were included victims in their 3rd decade (27.27%) of life followed by the victims in their 4th decade (21.89%) of life as compared to both extremes of age. The majority of the victims (68.25%) who were brought dead were belonging to the adult age group of 21-50 years. When brought dead cases were analyzed in contrast to their gender, then we found that the incidence of male victims (84.44%) was found 5.43 times higher than the female victims with a male to female ratio of 1: 0.18. Distribution by brought dead cases according to their religion and domicile shows that incidences were higher in Hindu people (83.94 %) as compared to Muslims (6.56%). There was not much difference in the incidence of the victims who were brought dead to us from urban (38.99 %) and rural (43.64 %) areas. We could not determine the religion in 9.5% cases, while the domicile of victims were not known in 17.37% cases. In the present study, analysis of brought dead cases, according to the cause of death shows that the highest number (40.1%) of the victims who were brought dead died due to accident including vehicular and railway accidents followed by pathology (16.2%) of some organs. In 11.1% cases we could not determine the cause of death after all efforts till the date of this study. The distribution of cases, according to the manner of death shows that in most of the victims who were brought dead to us, the manner of death was accidental (57.6%) in nature followed by suicidal cases (18.9%) and homicidal cases (1.6%). When the cases were analyzed in contrast to natural and unnatural means, then we found that the incidences of unnatural deaths (78.1%) were more as compared to natural deaths (21.9%).
Discussion
Death is permanent and irreversible stoppage of the all three vital systems of the body, including the circulatory, respiratory and neurological systems and in these cases a doctor is having a duty to pronounce the death and issue a certificate ascertaining the cause of death. Declaration of death is a tedious job to the doctor because he has to confirm by all means that the stoppage of vital functions is irreversible and permanent and on the other hand the doctor also has to inform the relatives about this shocking and painful news. But in the cases of brought dead the medical person who is attending the case first time in casualty department is not able to conclude the cause of death and hence the dead body is shifted to mortuary for the post-mortem examination to certify the cause of death. In the present study, we have analyzed the cases that were found dead clinically on arrival in casualty department and the results were compared with data of other researchers. The incidence of bringing dead cases in the present study was 31.7%. In our study majority of the victims (27.27%) were in their 3rd decade of life followed by the victims in their 4th decade (21.89%) of life, which is consistent with the findings of Tripude et al(6) while the Gupta et al found higher incidences in their study in 3rd-5th decade of life, which is probably due to different criteria of inclusion of the cases.(7) Most of the victims in our study were Hindu, males that are similar with the observations of other authors.(7,8) On analysis of cases according to their domicile we did not find much difference in the incidence of the victims who were brought dead to us from urban (38.99 %) and rural (43.64 %) areas. Even after all efforts, we could not find out the religion in 9.5% cases, while the domicile of victims could not be determined in 17.37% cases. In the present study majority of the victim who were received dead, died due to traumatic injury occurred in Road Traffic Accident (RTA) and railway accident, followed by pathology of any organs in the body, which is quite similar with the observations of others in their study. (6) The higher incidences in younger age groups are likely referable to the inclusion of the cases of trauma. In present study information from relatives and accompanying police records with autopsy details were used to conclude the manner of death and we found that the incidences of unnatural deaths (78.1%) were more as compared to natural deaths (21.9%), which is a common phenomenon of most of the autopsy studies.(6,8,9) In un-natural deaths majority of the victims died due to traumatic injury caused by accident in 57.6% cases, followed by suicidal deaths in 18.9% cases and homicidal deaths in 1.6% cases.
Conclusion
The pattern of cases of brought dead in present study is nearly alike to the other studies conducted at other centers. Our study revealed that most of the victims who were brought dead to us belonging to the Hindu males of the younger age group who died due to accidental trauma. The hospital administration should lead an initiative to smoothen the medico-legal issues linked to cases of received dead in casualty so the relatives who are already broken mentally do not suffer more. Finally more researches on this as well as other centers are required for better understanding the pattern of these cases and their different medico-legal issues.
Acknowledgement
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to Authors/Editors/Publishers of all those articles, journal and books from where the literature of this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=706http://ijcrr.com/article_html.php?did=7061. Reddy KSN and Murty OP: The Essentials of Forensic Medicine and Toxicology, 32nd Edition, K Sugnadevi, Hyderabad, 2013; 130-32.
2. Nandi A: Principles of Forensic medicine including Toxicology, 3rd Edition, New Central Book agency Pvt. Ltd., Kolkata, 2010; 221-26.
3. Vij K: Textbook of Forensic medicine and Toxicology, 5th Edition, Elsevier, 2011; 74-75.
4. Biswas G: Review of Forensic medicine and Toxicology, 2nd Edition, Jaypee brothers medical publishers, 2012; 107- 110.
5. Modi JP, Edited by Kannan K and Mathiharan K: A Textbook of Medical Jurisprudence and Toxicology, 24th Edition, Laxis Naxis Butterworth Wadhwa, Nagpur, 2012; 200-201.
6. Tripude B, Nagrale N, Murkey P, Zopate P and Patond S: medico legal profile of brought dead cases received at mortuary, J of Forensic Med, Sci and Law, 2012; Vol.21 (2): 1-8.
7. Gupta BD, Vaghela PC, Singh G and Mehta R: futility of post-mortem examination in ‘brought in dead’ cases: A retrospective study, JPAFMT, 2006; Vol.6, 9-10.
8. Chaturvedi M, Satoskar M, Khare MS and Kalgutkar AD: Sudden, unexpected and natural death in young adults of age between 18 years and 35 years: A clinic-pathological study, Ind J of Patho and Micro, 2011; Vol. 54(1): 47-50.
9. Bansal AK, Patel AP, Mittal P, Bhoot RR, Merchant SP and Patel PR: Pattern of spot death cases brought to V.S. General Hospital, Ahmedabad: A retrospective study, JIAFM, 2013; Vol.35(2): 131.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareInfant and young child feeding practices in an urban underprivileged area in Bangalore, Karnataka, India
English1518Jerome S. N.English Catherin N.English Sulekha T.EnglishIntroduction: Infant and young child feeding practices constitute a major component of child caring practices. These practices continue to be neglected in spite of their important role in the growth of infants. The prevalence of underweight, stunting and wasting among under-three children was found to be 47%, 45% and 16% respectively in India.
Objective: To assess the infant and young child feeding practices in an urban underprivileged area in Bangalore, Karnataka, India. Methods: It was a cross sectional study conducted in an urban slum area with a sample size of 61 mothers of children aged less than two years. A door to door survey was conducted during November 2012 to January 2013, using a validated questionnaire. Results: The study population comprised of 61 mothers of children aged less than two years. Th15/10/2014e mean age of the mothers was 24.1 ± 3.6 years. Among the study population 52.5% and 82.0% had fed their children with prelacteal feeds and colostrums respectively. Exclusive breast feeding up to six months was practiced by 54.2% of the mothers. Of all of them 59.0% initiated breastfeeding within one hour of birth. Only 41.7% of them started complementary feeds at six months of age. It was observed that 49.2% of the children were under nourished according to WHO (World Health Organization) weight for age growth charts. Conclusion: The study shows poor infant and young child feeding practices with poor nutritional status. There is need for promotion and protection of optimal feeding practices for improving nutritional status of infants.
EnglishInfant and young child feeding practices, Breast feeding, Nutritional status; IndiaINTRODUCTION
Breast feeding is the ideal way of providing food for the growth and development of infants. Infant-feeding practices constitute a major component of child rearing and caring practices.1 The World Health Organization (WHO) had recommended exclusive breastfeeding for every child for the first six months of life with early initiation and also recommended continuation of breastfeeding for first 2 years or more together with nutritionally-adequate, age-appropriate and safe complementary feeding starting at six months of life. 2 The prevailing rates show that early initiation within one hour of birth is 25%, exclusive breast feeding for six months is 46% and appropriate complementary feeding at six months is 57%.3 Also in a study conducted in a West Bengal Slum among 0-6 month age group, 39.6% children were initiated breast feeding within one hour of birth, pre-lacteal feeding was received by 27.1%. Exclusive breast feeding was noted in 52.1% in 0- 6 month of age children. One-fourth infants were bottle-fed and 12.5% received solid or semisolid food before six months. Among 6-23 months of age children, 95.9% children continued breast feeding. Along with this, the study showed 35.9% children underweight and 15.9% severely underweight in the slum setting.4 There are issues such as prelacteal feeding, delayed initiation of breast feeding, denial of colostrums, lack of exclusive breast feeding and several instances of improper weaning practices that lead to a vicious circle of under nutrition which stands at 43% below 3 years of age.3 More than half of all deaths in infants are attributable to under nutrition. Nearly 67% of the child deaths in India are due to the potentiating effects of malnutrition.5 There is a need to reduce infant mortality and improve the level of nutrition in children. The current statistics show that the infant mortality rate (IMR) still continues to be 47 per 1000 live births.6 In India, while the IMR has shown decline there still remains the need to accelerate improvements in infant and neonatal survival to achieve the Millennium Development Goal, to reduce IMR to 27 by 2015.7 One important way to reduce IMR is to ensure 100% exclusive breast feeding for the first six months of life followed by complementary feeding along with continued breast feeding. Recent studies on maternal and child under nutrition has estimated that nearly 1.4 million infant deaths can be prevented with exclusive breast feeding.8,9 The timely introduction of complementary feeding can prevent almost 6% of under-five mortality.10 We conducted this study to assess infant and young child feeding practices in infants below 24 months and their corresponding nutritional status in an urban underprivileged area in Bangalore, Karnataka.
Material and Methods
We conducted a community based cross sectional descriptive study. The criteria for selection was mothers of children within 0 to 24 months who gave consent to participate. The severely ill children and those with metabolic disorders were excluded from the study. Through convenient sampling we had a sample size of 61. Institutional ethical committee clearance was obtained for the study. The data was collected over a period of four months from November 2012 to February 2013. A door to door survey was conducted and 61 mothers were interviewed in Laxman Rao Nagar, Bangalore. Written informed consent was obtained and a validated questionnaire based on the Breast Feeding Promotion Network of India (BPNI) was administered, which has been modified according to our settings along with anthropometric measurements.11 The data was collected under four domains namely demography, antenatal care, feeding practices and anthropometry. The parameters to assess the nutritional status of children were measured and recorded according to standard protocols laid down by the Centre for Disease Control.12 The data was entered into SPSS software version 20.13 Tests of association like chi Square test was done. Under nutrition was assessed as per the WHO standardized growth charts.14 The results were tabulated and conclusions drawn.
Results
Totally 61 mothers were surveyed and the mean family size was 5.57 ± 2.3 persons with 41% of families falling within the class five socioeconomic scale category. BG Prasad’s social classification was used for the socioeconomic status classification.[15,16] The mean age of mothers was 24.13 ± 3.6 years and 42.6% of them had high school education. The average number of antenatal checkups was 8.02 ± 3.6 times and 82% of the mothers had a normal vaginal delivery. A total of 61 children under 24 months of age were included in the study of which 21.32% were below six months of age, 39.34% of them were within 6-12 months and 39.34% were 12-24 months category. The mean age was 11.59 ± 5.4 months. Of them 52.5% were females and 47.5% were males. In the study population, all the children were breast fed and out of which 52.5% were given prelacteal feeds with sugar water being the predominant prelacteal feed at 56.3%. Initiation of complementary feeding at six months was 41.7% in 6-24 months age group. Of the total study population 44.3% and 26.2% were fed rice with dhal and cerelac as the predominant mode of complementary feeding respectively. Each child received an average of 2.85 ± 0.79 meals per day as a part of complementary feeding. The prevalence of bottle feeding was 21.3%. The mean number of breast feeds in a day for the first six months of life was 7.69 ± 3.9 and 3.69 ± 1.5 during the day and nights respectively. During the next 6-24 months the mean number of feeds decreased to 4.44 ± 3.9 and 2.25 ± 1.9 during the day and night respectively. The feeding practices are shown in table 1. Of the study population 50.8% of the children had an episode of diarrhoea within two weeks prior to the survey and of which 41.9% of them received less than normal breast feeding during the period of illness. The prevalence of under nutrition, stunting and wasting was 49.2%, 60.7% and 31.1% respectively. Overall 22.6% of the children had severe under nutrition. There was no statistically significant association between income of the families, education of the mother and number of antenatal checkups with the infant feeding practices. There was no statistically significant association between the feeding practices and the nutritional status of the study group. The association between feeding practices and under nutrition is shown in table 2.
Discussion
In our study prelacteal feeding was given to 52.5% of the infants which is comparable to National Family Health Survey – 3 (NFHS-3) data (57.3%).2 However a similar study done in West Bengal showed 27.1%.3 The reasons could possibly be due to the prevailing tradition in the slum thereby exerting harmful effects on the infants.17 Colostrum was refused to 18% of the infants which is lower when compared to a study done in Allahabad where 54.8% of the mothers discarded colostrum. In the same study lack of colostrum feeding was associated with increased risk of under nutrition.18 Early initiation of breast feeding within one hour was followed by 59% of the respondents and studies have showed that early initiation of breastfeeding could reduce neonatal mortality by 22%.19 Exclusive breast feeding rate for the first six months among the infants within 6-24 months was 54.2% which throws light on the feeding practices pre-vailing in the urban slum. Though it is low the situation is better as compared to NFHS-3 which put the all India average at 46.4%.3 This could be attributed to the poor knowledge about optimal breast feeding practices. Another reason could be due to inadequate milk secretion by the mother as found by a study in rural Tamilnadu by Parmar et al.20,21 Promotion of exclusive breast feeding would go a long way in improving infant survival.8,9 The timely initiation of complementary feeding at six months was 41.7% in the 6-24 months age group which was much lower than Dehradun study (70.1%) but significantly better than 16.6% observed in Delhi slums.22,23 The mean number of complementary feeds per day was 2.85 + 0.79 which is close to the (Integrated Management of Neonatal and Childhood Illness) IMNCI recommendations.24 Complementary feeds bridge the energy gap, vitamin A gap and iron gap which arises in breastfed infants at six months.25 Thus there is a need to optimize the complementary feeding practices in the urban slum. Breastfed children at 12-23 months receive 35-40% of their total energy needs from breast milk thus emphasizing the need for continued breast feeding till two years of age.25 Continued breast feeding at one year was 60.6% in the12-24 month age group which is low. The prevalence of diarrhoea among the study group was 50.8% in the preceding two weeks of the survey which again could be attributed to increased patronage of prelacteal feeds, supplementary feeds like formula milk, bottle feeding (21.3%) and poor hygiene. Of all 41.9% mothers fed less than the usual number of breastfeeds during the period of illness which could predispose the child to under nutrition. Mortality related to diarrhoea mostly occurs in developing countries, and the highest rates of diarrhoea occur among malnourished children.26 The feeding practices though not significant statistically with under nutrition in our study, had been statistically significant in another study conducted by Dinesh Kumar et al.1
Conclusion
Optimized infant and young child feeding practices are the best way to improve child survival. Urgent steps are needed to ensure improved and optimal infant feeding practices which will help overcome the burden of Infant mortality and morbidity. Better perinatal counselling by health professionals and continued emphasis on feeding practices during immunization visits would be beneficial.
Acknowledgement
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=707http://ijcrr.com/article_html.php?did=7071. Dinesh Kumar, Goel NK, Poonam C, Mittal, Purnima Misra. Influence of Infant-feeding Practices on Nutritional Status of Under-five Children: Indian J Pediat 2006 May 73: 417- 22
2. World Health Organization. Global strategy for infant and young child feeding. Geneva: World Health Organization, 2003. 41
3. National Family Health Survey -3, IIPS, 2005-06
4. Mukhopadhyay DK, Sinhababu A, Saren AB, Biswas AB. Association of child feeding practices with nutritional status of under-two slum dwelling children: A communitybased study from West Bengal, India. Indian J Pub Heal 2013; 57:169-72.
5. Pelletier DL, Frongillo EA Jr, Schroeder DJ, Habicht JP. The effects of malnutrition on child mortality in developing countries. Bull Word Health Organ 1995;73: 443-8.
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8. Black RE, Allen LH, Bhutta ZA, Caulfield LE et al. Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet 2008 Jan; 371:243-60.
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10. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS; Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003;362:65-71
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16. BG Prasad Score: www.labourbureau.nic.in.htm Accessed on 12 Oct 2014.
17. Martines JC, Rea M, De Zoysa I. Breast feeding in the first six months. BMJ 1992;304:1068-9.
18. Dinesh Kumar, N.K. Goel, Poonam C. Mittal and Purnima Misra - Influence of Infant-feeding Practices on Nutritional Status of Under-five Children. Indian J Pediat 2006; 73 (5): 417-21.
19. Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics 2006;117:380-6.
20. Radhakrishnan S, Balamuruga S S. Prevalence of exclusive breastfeeding practices among rural women in Tamil Nadu. Int J Health Allied Sci 2012;1:64-7
21. Parmar VR, Salaria M, Poddar B, Singh K, Ghotra H, Sucharu. Knowledge, attitudes and practices regarding breast feeding at Chandigarh. Indian J Pub Heal 2000;44:131-3.
22. Dr. Vartika Saxena , Dr. Praveer Kumar. Complementary feeding practices in rural community: A study from block Doiwala district Dehradun. Ind J Basi App Medi Resear; March 2014:3(2); 358-63.
23. Sethi V,Kashyap S,Sethi V:Effects of Nutritional Education of mothers on Infant feeding practices.Indian J Pediat 2003,70:463-6.
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25. World Health organization. Global forum for child health research: a foundation for improving child health. Switzerland, Geneva, WHO, 2002.
26. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003;361: 2226-34.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareSTUDY OF PREVALENCE OF INTESTINAL PARASITES IN FOOD HANDLERS IN MANGALORE
English1921Roli SolankiEnglish Ramya Nidhi KaiyaEnglish Abhishek JaysawalEnglish Dhanashree B.English C. MeghnaEnglish Vidyalakshmi K.EnglishIntroduction: Food-handlers with a poor personal hygiene and dirty habits could be potential sources of infection due to pathogenicmicroorganisms. The study was undertaken to determine the prevalence of intestinal protozoan and helminthic parasites among food handlers in a hostel and canteen. Objectives: To detect the intestinal protozoan and helminthic parasites in the stool samples of food handlers and to correlate parasitic infection levels with hygiene and educational level Materials and Methods: Faecal samples of 197 food-handlers were collected of both sexes working in the hostel mess and canteen of Kasturba Medical College and Hospital, Mangalore for a period of one year. The collected faecal samples were subjected to direct microscopic examination using saline and iodine wet mount and concentration technique using formalin-ethyl acetate and staining the smears by modified Ziehl-Neelsen’s method.
Result: Among the 197 food-handlers included in the study 114 were males and 83 were females. There were no RBC, ova, trophozoites or cyst in the stool samples tested. Pus cells were found only in 18 samples. However none of the food-handlers were found positive for protozoan cysts and helminthic ova. Conclusion: There was no prevalence of parasitic infection among the food handlers. The findings highlight that food-handlers working in our institution have good-personal hygiene and good health education. Moreover all food handlers used personal protective equipment and take good care while handling food.
EnglishProtozoa ova, Helminthic eggs, Food handlersINTRODUCTION
Food is a basic requirement and is necessary for survival of all living beings. Intestinal parasitic infections are among the most common infections worldwide. Food handlers with poor hygiene could be the source of intestinal parasitic infections. Improper handling of food and lack of regular hand washing habits may lead to spread of pathogens from food handlers to the consumers1 . Food-borne diseases have been affecting large number of people worldwide and is an important public health problem2 . Food-handlers with poor personal hygiene working in hotels, hostel mess and other catering services have been reported to be potential sources of intestinal helminths and protozoa from many developed and developing countries all over the world1,2,3,4,5. Strong association between personal hygiene of food handlers and intestinal parasitic infections was observed by few of the North Indian studies especially from Amritsar and Sholapur cities6, 7, 8. However there are no reported or published cases of food handlers being identified as potential sources of infection from this part of the country. Hence an attempt is made in the present study to screen food handlers in hostel mess and canteen to know the prevalence of parasitic infections among food handlers in this part of the country.
MATERIALS AND METHODS
This is a cross sectional study conducted for a period of one year, which included 197 food- handlers working in the hostel mess (n=09) and canteen (n=03) of Kasturba Medical College (KMC) and KMC Hospital, Mangalore. This study was approved by the Institutional ethics committee. Food handlers who were not on any treatment for intestinal ailment for three months prior to the study were included in screening test. Exclusion criteria included persons suffering from diarrhoeal diseases and those on therapy for intestinal infections. A structured questionnaire was given to the participants for collecting information like age, sex, education level, and hygienic status of each food-handler. Three faecal samples on alternate days were collected from each food handler in a sterile, dry container and transported to the laboratory within one hour of collection. Macroscopic examination9 was done with the naked eye for the colour, consistency, mucus and presence of worms. Direct microscopic examination10 was done using saline and iodine mount to demonstrate the RBC, WBC, ova, larvae, trophozoites and cysts. The Formalin-ethyl acetate concentration procedure was used to check for ova and cyst of intestinal parasites in the stool samples followed by modified Ziehl-Neelsen’s staining for the detection of Cryptosporidium and Isospora oocysts 9,11. Results were summarized as frequency tables.
RESULTS
Among 9 hostel messes and 3 canteens a total of 197 food handlers were screened for parasitic infections. Among them 114 were males and 83 were females. Pus cells were found only in 18 stool samples. RBC, ova or cyst or parasitic larvae were not detected in any of the samples screened. There were 15 workers who had the habit of nail-biting. All the workers used personal protective equipment such as gloves, apron and head caps while handling food. Among the 197 food-handlers screened, none of them were found to be positive for any intestinal ailment or any parasitic infection. Educational levels of the food handlers, adherence to hygiene and habits are as shown in Figure 1 and Table 1
DISCUSSION
People working in cafeterias and various catering services with unhygienic habits of handling food may act as potential sources of infection as they can spread infection to the food consumers. Several authors have highlighted food handlers as means of transmission of parasitic and bacterial diseases³. In earlier studies, the most commonly reported infectious agents spread through food were Entamoeba histolytica, Giardia duodenalis, Strongyloides stercoralis and Ascaris lumbricoides. However in our study none of the food handlers harboured any parasitic ova, cysts or larval forms. A cross-sectional study from University of Gondar, showed the prevalence of intestinal parasites to be 29.1% which involved food-handlers working in their cafeterias4 . Similarly, another cross sectional study from Makkah, Saudi Arabia showed a prevalence rate of intestinal parasites to be 23% 2 . In all these previously reported studies most commonly detected pathogenic protozoa were E.histolytica (2.78%) and G.lamblia (1.98%).2,14 An Indian study involving mess workers from educational institute found E.histolytica, and A.lumbricoides to be harboured by these workers. Evidence of G.lamblia infestation was found in 5 (17.8%), T. solium in 2 (7:2%) and Strongyloidosis in 1 (3.6%) of the food handlers14. A vast majority of intestinal parasitic infections was observed in those who were either not washing their hands after visiting toilet or washing their hands improperly. Infection was also observed in those food handlers having dirty and untrimmed nails / having the habit of nail biting.14 However in the present study though 11 male and 3 female food handlers had the habit of nail biting, their stool samples were negative for parasitic ova and cysts. There were no intestinal parasites detected in the stool samples of food-handlers screened in our study. Our result contrasted the outcome of other studies which revealed presence of parasites in stool samples of food handlers. The absence of intestinal parasites among food handlers in our setup could be related to standard quality of education on good sanitation practices, especially thorough hand washing, personal hygiene measures and use of personal protective equipment like gloves, masks, head caps and aprons.
CONCLUSION
The prevalence of intestinal parasites of the food handlers is not seen in this study. Good personal hygiene and hygienic food-handling practices are effective means of preventing the transmission of intestinal parasites from food handlers to the consumers. Effective training and education on personal hygienic habits such as thorough hand washing before work, use of personal protective equipment provided to all food handlers can help to control intestinal parasitic infections.
ACKNOWLEDGEMENT
The authors are grateful to Manipal University, Head of the Institution and Head of the Department of Microbiology, Kasturba Medical College, Mangalore (A constituent college of Manipal University) for their encouragement and support.
Englishhttp://ijcrr.com/abstract.php?article_id=708http://ijcrr.com/article_html.php?did=7081. Takizawa MGMH, Falavigna DLM, Gomes ML. Enteroparasitosis and their ethnographic relationship to food handlers in a tourist and economic center in Paraná, southern Brazil. Rev Inst Med trop S Paulo 2008; 51: 31- 35.
2. Zaglool DA, Khodari YA, Othman RAM, Farooq MU. Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital. Nigerian Medical Journal 2011; 52: 266-270.
3. Salem KA. Infectious diseases among food handlers. J Egypt Public Health Assoc1998; 73:563-75.
4. Andargie G, Kassu A, Moges F, Tiruneh M, Huruy K. Prev- Andargie G, Kassu A, Moges F, Tiruneh M, Huruy K. Prevalence of Bacteria and intestinal parasites among foodhandlers in Gordon town North West, Ethiopia. J Health Popul Nutr 2008; 26:451-455.
5. Nyarango RM, Aloo PA, Kabiru EW, Nyanchongi1 BO. The risk of pathogenic intestinal parasite infections in Kisii Municipality, Kenya. BMC Public Health 2008; 8:237 -239.
6. Mohan A. An evaluation of health status of food handlers of eating establishments in various educational and health institutions in Amritsar city. Indian J Community Med 2001; 26: 80-84.
7. Khurana S, Taneja N, Thapar R, Sharma M, Malla N. Intestinal bacterial and parasitic infections among food handlers in a tertiary care hospital of North India. Tropical Gastroenterol 2008; 29: 207-209
8. Takalkar AA, Madhekar NS, Kumavat AP, Bhayya AM. Prevalence of intestinal parasitic infections amongst food handlers in hotels and restaurant in Sholapur city. Indian Journal of Public health 2010; 54: 47-48.
9. Garcia LS. Test for the detection of parasites. In: Diagnostic medical parasitology, 4th ed. ASM press: Washington DC. 2007, p.741-785
10. World Health organization. Basic Laboratory methods in Medical Parasitology, Geneva: WHO, 1991; pp. 1- 69.
11. Truant AL, Elliott SH, Kelly MT, Smith JH. Comparison of formalin-ethyl ether sedimentation, formalin-ethyl acetate sedimentation, and zinc sulphate flotation techniques for detection of intestinal parasites. J Clin Microbiol 1981; 13: 882-884.
12. Wakid MH, Azhar EI, Zafar TA. Intestinal parasitic infections among food handlers in the Holy city Makkah during Hajj season. JKAU: Med. Sci. 2009; 16:39-52.
13. Donato G. Esparar. Prevalence of Intestinal Parasitic Infections among Food Handlers of a Tertiary Hospital in Manila using Direct Fecal Smear and Formalin Ether Concentration Technique. Phil J Microbiol Infect Dis 2004; 33(3):99-103
14. Mohan U, Mohan V, Raj K. A Study of Carrier State of S. Typhi, Intestinal Parasites and Personal Hygiene amongst Food Handlers in Amritsar City. Indian J of Community Medicine 2006; 21:2.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareAN EXTREMELY RARE REPORT OF FINDING MULTIPLE HOOKWORMS IN THE JEJUNAL PART OF GASTROJEJUNOSTOMY STOMA INSTEAD OF ITS USUAL SITE IN DUODENUM WHILE DOING UPPER GASTRO INTESTINAL ENDOSCOPY
English2224Govindarajalu GanesanEnglishWhile doing upper gastro intestinal endoscopy hookworms are most commonly found in duodenum and very rarely in stomach. But interestingly multiple hookworms were seen in the jejunal part of gastrojejunostomy stoma while doing upper gastro intestinal endoscopy in a 45 year old female patient who had undergone Truncal Vagotomy and gastrojejunostomy. Such endoscopic finding has not been reported so far. The patient underwent upper gastro intestinal endoscopy since she had dyspepsia for the last few months. But infection with multiple hookworms was found to be the cause of her dyspepsia after endoscopy. Hence upper gastro intestinal endoscopy is a very useful investigation to diagnose hookworm infection of duodenum, stomach and even the jejunal part of gastrojejunostomy stoma.
EnglishHookworm, Upper gastro intestinal endoscopy, Jejunal part of gastrojejunostomy stomaINTRODUCTION
There has been many reports of finding hookworms in duodenum while doing upper gastro intestinal endoscopy (1to10). Rarely hookworm is also reported to occur in stomach while doing upper gastro intestinal endoscopy (10to13). But there has been no reports of finding hookworms in the jejunal part of gastrojejunostomy stoma while doing upper gastro intestinal endoscopy. Hence an extremely rare report of finding multiple hookworms in the jejunal part of gastrojejunostomy stoma while doing upper gastro intestinal endoscopy is given here.
CASE REPORT
A 45 year old female patient who had undergone Truncal Vagotomy and gastrojejunostomy before six years and having dyspepsia for the last few months was subjected to upper gastro intestinal endoscopy. But very interestingly multiple hookworms were found actively moving in the jejunal part of gastrojejunostomy stoma (Fig 1,2). The head and the mouth of the hookworm is bent backward dorsally like a hook (Fig3) giving the name hookworm to it. It is S-shaped due to its dorsal bend at the head end (Fig3,4). Locomotion is by longitudinal muscles on one side contracting, while the other side expands, deforming the body into S-shaped curves (Fig 2,3,4). Two hookworms lying extremely close to one another (Fig 1) were retrieved out using biopsy forceps and immediately sent for microbiological examiniation. By microbilogical examiniation the two hookworms were identified as male and female hookworms and were also identified as Ancylostoma duodenale. The patient was treated with a single dose of 400mg of albendazole and her symptoms resolved.
DISCUSSION There are two human-specific hookworms, namely Ancylostoma duodenale and Necator americanus (4). Usually, the diagnosis of hookworm infection is made by the characteristic egg shape appearance on faecal examination (4). However, misdiagnosis is due to the absence of eggs of the parasites in stools (4). In such situation upper gastro intestinal endoscopy becomes an extremely useful investigation to diagnose hookworm infection (4). Hookworm is an elongated, unsegmented round worm belonging to the the Phylum Nematoda. When a round worm is found during upper gastrointestinal endoscopy, differential diagnosis is important to determine the diagnosis for the appropriate treatment (4). This can be achieved according to the morphology of the worms under microscopy and their location in the gastro intestinal tract (4). The common intestinal worms include Ascaris lumbricoides, Trichuris trichiura (whipworm), Enterobius vermicularis (pinworm), Strongyloides stercoralis and Anisakis simplex in addition to hookworms (Ancylostoma duodenale and Necator americanus) (4). Ascaris is a large roundworm (15-40cm in length) and inhabits the small intestine (4). Whipworm is 30-50mm in length and inhabits the large intestine (especially around caecum ) (4). Pinworm (10mm in length) also inhabits the same areas as the whipworm (4). Therefore, both the parasites are very rarely observed during upper gastrointestinal endoscopy (4). Strongyloides stercoralis inhabits the mucosa of duodenum or upper jejunum and is pretty small (2-3 mm in length) and relatively rare (4). The larva of anisakis simplex is found usually in the stomach of human beings and measures 2cm in length. Hookworms usually reside in the upper portion of the small intestine (4). In our study also multiple hookworms were found in the jejunal part of gastrojejunostomy stoma. Hence in our study also, hookworms were found to reside in the upper portion of the small intestine. Hookworm is identified by its characteristic bent head giving it a hook like appearance (Fig3,4). Hookworm is also Sshaped due to its bend at the head end (Fig3,4). Locomotion is by longitudinal muscles on one side contracting, while the other side expands, deforming the body into Sshaped curves (Fig 2,3,4). By all these features the round worm seen in this patient was identified as hook worm. The worms were also retrieved out using biopsy forceps and by microscopic examiniation were also confirmed as Ancylostoma duodenale. This patient presented with dyspepsia and upper gastro intestinal endoscopy was carried out in this patient due to her dyspepsia. But infection with multiple hookworms was found to be the cause of her dyspepsia after upper gastro intestinal endoscopy. Thus hookworm infection can present with dyspepsia and upper gastro intestinal endoscopy is a very useful investigation to diagnose hookworm infection.
CONCLUSION
Hence upper gastro intestinal endoscopy is very useful to diagnose the presence of hookworms in duodenum, stomach and even in the jejunal part of gastrojejunostomy stoma. Hence upper gastro intestinal endoscopy is a very useful investigation to diagnose hookworm infection of the entire gastro intestinal tract.
ACKNOWLEDGEMENT
The author sincerely thanks G. Kumaresan, computer engineer, for his immense help in labeling the figures of this article. The author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The author is extremely grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=709http://ijcrr.com/article_html.php?did=7091. Hyun HJ, Kim EM, Park SY, Jung JO, Chai JY, Hong ST . A case of severe anemia by Necator americanus infection in Korea. J Korean Med Sci. 2010 Dec;25(12):1802-4.
2. Kato T, Kamoi R, Iida M, Kihara T.Endoscopic diagnosis of hookworm disease of the duodenum J Clin Gastroenterol. 1997 Mar;24(2):100-102
3. Kibiki GS, Thielman NM, Maro VP, Sam NE, Dolmans WM, Crump JA. Hookworm infection of the duodenum associated with dyspepsia and diagnosed by oesophagoduodenoscopy: case report. East Afr Med J. 2006 Dec;83(12):689- 92.
4. Wu KL, Chuah SK, Hsu CC, Chiu KW, Chiu YC, Changchien CS. Endoscopic Diagnosis of Hookworm Disease of the Duodenum: A Case Report. J Intern Med Taiwan 2002;13:27- 30.
5. Kuo YC, Chang CW, Chen CJ, Wang TE, Chang WH, Shih SC . Endoscopic Diagnosis of Hookworm Infection That Caused Anemia in an Elderly Person. International Journal of Gerontology. 2010 ; 4(4) : 199-201
6. Zaher, T. I., Emara, M. H., Darweish, E., Abdul-Fattah, M., Bihery, A. S., Refaey, M. M., and Radwan, M. I. Detection of Parasites During Upper Gastrointestinal Endoscopic Procedures. Afro-Egypt J Infect Endem Dis 2012; 2 (2): 62-68.
7. Mahadeva S, Qua C-S, Yusoff W, et al. Repeat endoscopy for recurrent iron deficiency anemia: an (un)expected finding from Southeast Asia. Dig Dis Sci 2007;52:523–525
8. Reddy SC, Vega KJ. Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointest Endosc May 2008;67(6) 990-992
9. Nakagawa Y, Nagai T, Okawara H, Nakashima H, Tasaki T,Soma W, et al. Comparison of magnified endoscopic images of Ancylostoma duodenale (hookworm) and Anisakis simplex.Endoscopy 2009;41(Suppl. 2):E189
10. LEE, T.-H., YANG, J.-c., LIN, J.-T., LU, S.-C. and WANG, T.- H. Hookworm Infection Diagnosed by Upper Gastrointestinal Endoscopy: —Report of Two Cases with Review of the Literature—. Digestive Endoscopy, 1994 6(1): 66–72
11. Thomas V, Jose T, Harish K, Kumar S. Hookworm infestation of antrum of stomach. Indian J Gastroenterol 2006 May-Jun;25(3):154
12. Dumont A, Seferian V, Barbier P.Endoscopic discovery and capture of Necator Americanus in the stomach. Endoscopy. 1983 Mar;15(2):65-6.
13. Rana SS, Bhasin DK, Sinha SK ). Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection. Gastrointestinal endoscopy, 2008 Nov; 68(5), 1023.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareMETHOD OF COLOURING WET SPECIMEN IN ANATOMY
English2528Lalit Kumar JainEnglish Hitesh BabelEnglishAim: To develop a technique to colour the various important structures of a specimen which can be kept in 10 percent formalin filled jar in museum. Methodology: Previously several workers used different regins to colour the specimen but we used camlin oil paints mixed with white enamel paint to colour arteries, Veins, Nerves, Ligaments and Muscles of the specimens. These coloured specimens were kept in 10 percent formalin filled jar. Results: The painted colours remained stable in the formalin solution for several years without any visible changes. Conclusion: Colouring the important structures by using the anatomically correct colours make the monochrome specimens more attractive and lively and thus help students in identification and understanding of relations of various structures in a specimen.
EnglishMuseum, Artery, Vein, Nerve, Oil paint, White enamel paint, Formalin solutionINTRODUCTION
Museum in anatomy is a place where students get much information about the normal anatomical parts along with variation in the distribution of Nerves, vessels etc. Mounting the specimen as such in formalin solution filled jar may not look more informative as well as attractive. The text books which include coloured diagrams give full knowledge to the students. Many workers used different techniques to colour specimens. Congdon, E. D. (1932) used albuminous paints to colour the specimen (1). Intravascular injection of silicone, gelatin, latex or epoxy was used to highlight the vessels (Tiedemann,1982; von Hagens, 1985; Oostrom, 1987; Oostrom and von Hagens, 1988; Riepertinger and Heuckendorf, 1993; Grondin and Olry, 1996). Robert W. Henry, Larry Janick, and Carol Henry (1997) used silicon to colour plastinated specimens(2). Although everything of the specimen are essential but the important parts dissected may be highlighted in wet specimen with the permanent colours. We used camlin oil paints mixed with white enamel paint to colour the specimens. These coloured specimens can be kept in 10 percent formalin filled jar. By this technique arteries, Nerves, Veins, Ligaments, Tendons and even Muscles can be coloured which remain permanently in 10 percent formalin filled glass jar. Hence a technique has been developed which can be used to colour desired structures in wet specimen. Same technique was also used by the author to colour various structures of dry specimen (3).
MATERIAL AND METHOD
The material required for the technique are camlin oil paints, white synthetic enamel paint, painting brushes of different sizes and turpentine oil for cleaning the brushes. The specimen is prepared by fine dissection of the human body parts either fresh or left after dissection by students. When the specimen is prepared it is kept in a room for one or two days to make the surface of the structures to be coloured like vessels, Nerves, Ligaments Muscles, ducts, glands dry enough to apply colour. Now the vessels, Nerves, etc are raised from the underlying Muscles by putting swab of cotton under them which results in early drying of structures without drying of Muscles. The vessels and nerves dry earlier than other structures so colour is applied first on them and then on others. On a glass plate desired shade of colour is prepared by mixing the oil tube colour (camlin) with white enamel paint, when desired shade is prepared it is painted on the structures. We used Pink / Red colour for Artery, Blue for Vein, and Yellow for Nerve etc.
The oil paints are water proof and when mixed with white enamel colour they become adherent on the structures. After painting all the structures which are to be painted, specimen is kept overnight to make the paint dry. Now the specimen is put in the glass jar supported by cylindrical pieces of pet bottle(4) and jar is filled with 10 percent solution of formalin then the jar is covered with lid and sealed by cello tape or wax.
RESULT
By this technique various important structures of specimens were painted with anatomically correct colours. Colours evenly spread over the structures. The coloured specimens were kept in 10 percent formalin filled jars and have not shown any visible changes in colour for the last 5 years. With this technique it became easier for the students to understand relations of various structures in the specimen.
DISCUSSION
Many workers have worked on different techniques to colour to specimen with or without plastination. We used this technique to colour wet specimens which can be kept in jars filled with 10 percent formalin solution without any visible changes in colours. Cares to be taken: 1. Allow the Specimen to dry slightly before applying the paint 2. Structures which became dry should be painted first while others which are still wet may be coloured when they become dry.
ADVANTAGES OF USING COLOURED LABELLED SPECIMENS:
1. Colours aids memory. 2. Makes the specimen attractive. 3. Better distinguish anatomical Structures. 4. Creates interest of students. 5. Helps in better understanding of relations of different structures.
ADVANTAGES OF THIS TECHNIQUE:
1. Can be used for wet specimens.
2. Colours do not fade in formalin with time.
3. Convenient to perform.
4. Colours are well adherent to tissues.
5. Evenly colour the structures.
6. Colours can be stored at room temperature.
7. Great range of Colours are easily available.
CONCLUSION
From the results of above technique it can be concluded that coloured anatomical specimens are very valuable in teaching students of medical science. Colouring the important structures by using the anatomically correct colours make the monochrome specimens more beautiful and lively. As we human beings are very sensitive to colours it aids memory. So in brief it’s a better way of presentation of the specimens.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=710http://ijcrr.com/article_html.php?did=7101. Congdon, E. D. The use of albuminous paints in anatomical preparations. The Anatomical Records, volume 51, issue 3, pages 327–331, January 1932.
2. Robert W. Henry, Larry Janick, and Carol Henry. Specimen Preparation for Silicone Plastination. Journal of the International Society for Plastination, Volume 12, Number 1:13- 17, 1997.
3. Lalit kumar Jain, Pooja Rajendra Gangrade, Neha Vijay. New technique for preparation of dry specimen using discarded cadaveric parts. International journal of Current Research and Review, September 2012/ Volume 04, issue18, pages 71-77.
4. Lalit Kumar Jain et al. New Technique to Mount Specimen in the Formalin Filled Jar for Anatomy Museum with Almost Invisible Support. International Journal of Current Research and Review, June 2013/ Volume 05, issue 12, Pages 45-50.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN-0001November30HealthcareEARLY DETERIORATION IN QUALITY OF LIFE AND PHYSICAL FUNCTIONING OF MULTIPLE SCLEROSIS PATIENTS
English2938Ozge ErtekinEnglish Serkan OzakbasEnglish Egemen IdimanEnglishObjectives: (1) To examine the associations among ambulatory capacity, physical functioning and quality of life (QOL) in multiple sclerosis patients with different disability levels and compare the results to the healthy controls, and (2) to explain the relationship between QOL, disability status and disease duration. Methods: 112 multiple sclerosis patients and 50 healthy controls were selected for the study. Clinical and demographic data were recorded. Disability status (EDSS), walking ability and capacity (MSWS-12, T25FW), physical functioning (SF-36 /PF-10), QOL (MUSIQOL) and disease severity (MSIS-29) were evaluated. Outcome results of two subgroups with mild and moderate ambulatory impairment were analysed and compared with the control group. Results: There were a statistically significant difference between multiple sclerosis patients with low to moderate disability in MSWS-12, T25FW, SF-36 (PF-10) (pEnglishMultiple sclerosis, Disability, Walking, Physical functioning, Quality of lifeINTRODUCTION
Multiple sclerosis (MS) is a chronic demyelinating disease resulting in functional limitations, disability and reduced quality of life (QOL) through the impairments such as muscular weakness, ataxia, spasticity, balance dysfunction, general fatigue, sensory disturbances, and visual vestibular disturbances1 . Walking ability, a marker of both disability and disease progression, is the most important part of physical disability in MS and has the major interest in rehabilitation 2,3,4,5,6,7. Although van Asch3 reported that the appearance of mobility difficulties were seen in almost all patients within 10 years of diagnosis, mobility impairment can begin early stages in the disease, with only one year of diagnosis. Recent studies have indicated that MS patients consider mobility impairment to be the most concerned symptom3,4, which have a significant impact on daily live and participation5,6. As shown in our recently published study, it has also a significant and long-term burden on caregivers, not restricted only to the patients’ life 7 . MS is not only associated with mobility loss, but it also has a severe negative impact on QOL. Previous research has shown that mobility impairment is an important cause of disability and reduced QOL in patients with MS, even when mobility loss is mild8,9,10, which may occur even in early stages of the disease11,12. MS patients having mild mobility disability in clinical assessments may have limitation in especially outside activities such as stairs and transportation, which may interrupt their QOL status earlier than expected. On the other hand, it will be not sufficient when walking impairment will evaluated without the environmental factors. Recently, Cavanaugh et al.12 reported that the ambulatory activity includes not only walking speed or cadence; it refers also physical activity behaviour such as walking, jogging, stair climbing, which includes daily activities in life. The quality of life deteriorations and mobility impairments appeared in multiple sclerosis at the mild to mod erate disability level may be an important determinant of long-term MS rehabilitation goals and need further investigation as well as it’s relation with physical functioning and disease duration. Thereby it will be possible to provide the appropriate physiotherapy and rehabilitation approaches on aspects of location, duration and intensity. Our purposes were (a) to examine the associations among ambulatory capacity, physical functioning and QOL in MS patients with different disability levels and compare the results to the healthy controls (b) to explain the relationship between QOL and disability status as well as disease duration. METHOD Participants: 112 ambulatory individuals with Multiple Sclerosis (MS) referred to the Multiple Sclerosis Outpatient Clinic of Neurology Department of the Dokuz Eylul University School of Medicine were assessed for eligibility. Inclusion criteria of the study were 1) clinically or laboratory definite relapsing remitting, primary progressive or secondary progressive multiple sclerosis according to Poser’s criteria13 2) aged 18-75 years, 3) EDSS between 1.0 and 6.5, 4) cooperated, and 5) volunteer to join to the study. Patients were excluded if their diagnosis was not clearly established (n=2), they were suffering from an acute relapse (in the last 30 days) prior to the first examination (n=9), history of cardiovascular (n=5), respiratory (n=2), orthopaedic (n=18), psychiatric (n=3), or other unstable medical co-morbidities (n=2), and having depression according to Beck Depression Scale (n=11). The study was approved by the head of the department and passed the ethics committee review of the university. Written informed consent was received from all participants. The physical therapist administered the evaluation scales. EDSS was performed by the neurologist. Data Collection: Demographic characteristics, socioeconomic status and medical history recorded by questionnaire included age, gender, height, weight, and body mass index, education, employment, disease duration, assistive device use (cane/canadian), and EDSS group specified for both total MS patients and subgroups. Disability Status: The severity of disability was stated with the Kurtzke Expanded Disability Status Scale (EDSS)14. Patients were subdivided in subgroups with mild (EDSSEnglishhttp://ijcrr.com/abstract.php?article_id=711http://ijcrr.com/article_html.php?did=7111. Motl RW, McAuley E, Snook EM, Gliottoni RC. Physical ac- Physical activity and quality of life in multiple sclerosis: intermediary roles of disability, fatigue, mood, pain, self-efficacy and social support. Psychol Health Med 2009; 14(1):111-24.
2. Weikert M, Suh Y, Lane A, Sandroff B, Dlugonski D, Fernhall B, et al. Accelerometry is associated with walking mobility, not physical activity, in persons with multiple sclerosis. Med Eng Phys. 2012; 34(5): 590-7.
3. Van Asch P. Impact of mobility impairment in multiple sclerosis 2 patient perspectives. Eur Neurol Rev. 2011; 6: 115–20.
4. Heesen C, Bohm J, Reich C, Kasper J, Goebel M, Gold SM. Patient perception of bodily functions in multiple sclerosis: gait and visual function are the most valuable. Mult Scler. 2008; 14: 988–91.
5. Kieseier BC, Pozzilli C. Assessing walking disability in multiple sclerosis. Mult Scler. 2012; 18(7): 914-24.
6. Panitch H, Applebee A. Treatment of walking impairment in multiple sclerosis: an unmet need for a disease-specific disability. Expert Opin Pharmacother. 2011; 12(10): 1511- 21.
7. Ertekin Ö, Özakba? S, ?diman E. Caregiver Burden, Quality of Life and Walking Ability in Different Disability Levels of Multiple Sclerosis. NeuroRehabilitation 2014; 34: 313-21.
8. Aronson KJ. Quality of life among persons with multiple sclerosis and their caregivers. Neurology 1997; 48: 74-8.
9. Chruzander C, Ytterberg C, Gottberg K, Einarsson U, Widén Holmqvist L, Johansson S. A 10-year follow-up of a population-based study of people with multiple sclerosis in Stockholm, Sweden: changes in health-related quality of life and the value of different factors in predicting healthrelated quality of life.J Neurol Sci. 2014; 15: 339(1-2):57- 63.
10. Paltamaa J, Sarasoja T, Leskinen E, Wikström J, Mälkiä E. Measures of physical functioning predict self-reported performance in self-care, mobility, and domestic life in ambulatory persons with multiple sclerosis. Arch Phys Med Rehabil. 2007; 88: 1649-57.
11. Salter AR, Cutter GR, Tyry T, Marrie RA, Vollmer T. Impact of loss of mobility on instrumental activities of daily living and socioeconomic status in patients with MS. Curr Med Res Opin. 2010; 26: 493-500.
12. Cavanaugh JT, Gappmaier VO, Dibble LE, Gappmaier E. Ambulatory activity in individuals with multiple sclerosis. J Neurol Phys Ther. 2011; 35(1): 26-33.
13. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, et al. New diagnostic criteria for multiple sclerosis: guideliness for reserach protocols. Ann Neurol. 1983; 13: 227-31.
14. Kurtzke JF. Rating neurological impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology. 1983; 33: 1444-52.
15. Ertekin Ö, Özakbas S, diman E, Algun ZC. Quality of Life, Fatigue and Balance Improvements after Home-Based Exercise Programme in Multiple Sclerosis Patients. Archives of Neuropsychiatry. 2012; 49 (1): 33-8.
16. Hobart JC, Riazi A, Lamping DL, Fitzpatrick R, Thompson AJ. Measuring the impact of MS on walking ability: The 12-Item MS Walking Scale (MSWS-12). Neurology. 2003; 60: 31-6.
17. Gijbels D, Dalgas U, Romberg A, de Groot V, Bethoux F, Vaney C, et al. Which walking capacity tests to use in multiple sclerosis? A multicentre study providing the basis for a core set. Mult Scler. 2012; 18 (3): 364-71.
18. Koçyiit H, Aydemir Ö, Fi?ek G, Ölmez N, Memi A. K?sa Form-36 (KF-36)’nn Türkçe versiyonunun güvenilirli?i ve geçerlili?i. ?laç ve Tedavi Dergisi. 1999; 12: 102-6.
19. Nogueira LA, Nóbrega FR, Lopes KN, Thuler LC, Alvarenga RM. The effect of functional limitations and fatigue on the quality of life in people with multiple sclerosis. Arq Neuropsiquiatr. 2009; 67(3B): 812-7.
20. Simeoni MC, Auquier P, Fernandez O, Flachenecker P, Stecchi S, Constantinescu CS, et al, on behalf of the MUSIQOL study group. Validation of the Multiple Sclerosis International Quality of Life questionnaire. Mult Scler. 2008; 14(2): 219-23.
21. Hobart J, Lamping D, Fitzpatrick R, Riazi A, Thompson A. The Multiple Sclerosis Impact Scale (MSIS-29): a new patient-based outcome measure. Brain. 2001; 124(Pt 5), 962-73.
22. Martin CL, Phillips BA, Kilpatrick TJ, Butzkueven H, Tubridy N, McDonald E, et al. Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler. 2006; 12: 620-8.
23. Dalgas U, Kjølhede T, Gijbels D, Romberg A, Santoyo C, de Noordhout BM, et al. Aerobic intensity and pacing pattern during the six-minute walk test in patients with multiple sclerosis. J Rehabil Med. 2014; 46(1): 59-66.
24. Hutchinson B, Forwell SJ, Bennett S, Brown T, Karpatkin H, Miller D. Toward a consensus on rehabilitation outcomes in MS: gait and fatigue. Int J MS Care. 2009; 11: 67-78.
25. Fischer JS, Rudick RA, Cutter GR, Reingold SC. The Multiple Sclerosis Functional Composite Measure (MSFC): an integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force. Mult Scler. 1999; 5(4): 244-50.
26. Kragt JJ, van der Linden FA, Nielsen JM, Uitdehaag BM, Polman CH. Clinical impact of 20% worsening on Timed 25-foot Walk and 9-hole Peg Test in multiple sclerosis. Mult Scler. 2006; 12(5): 594-8.
27. Rudick R, Antel J, Confavreux C, Cutter G, Ellison G, Fischer J, et al. Recommendations from the national multiple sclerosis society clinical outcomes assessment task force. Ann Neurol. 1997; 42(3): 379–82.
28. Kaufman M, Moyer D, Norton J. The significant change for the Timed 25-foot Walk in the multiple sclerosis functional composite. Mult Scler. 2000; 6(4):286-90.
29. Johansson S, Ytterberg C, Claesson IM, Lindberg J, Hillert J, Andersson M, et al. High concurrent presence of disability in multiple sclerosis. Associations with perceived health. J Neurol. 2007; 254(6): 767-73.
30. De Groot V, Beckerman H, Uitdehaag BM, de Vet HC, Lankhorst GJ, Polman CH, et al. The usefulness of evaluative outcome measures in patients with multiple sclerosis. Brain. 2006; 129: 2648–59.
31. Einarsson U, Gottberg K, Fredrikson S, von Koch L, Holmqvist LW. Cognitive and motor function in people with multiple sclerosis in Stockholm County. Mult Scler. 2006; 12: 340-53.
32. Zwibel HL. Contribution of impaired mobility and general symptoms to the burden of multiple sclerosis. Adv Ther. 2009; 26(12): 1043-57.
33. Sutliff MH. Contribution of impaired mobility to patient burden in multiple sclerosis. Curr Med Res Opin. 2010; 26(1): 109-19.
34. Klevan G, Jacobsen CO, Aarseth JH, Myhr KM, Nyland H, Glad S, et al. Health related quality of life in patients recently diagnosed with multiple sclerosis. Acta Neurol Scand 2014; 129(1):21-6.
35. Pugliatti M, Riise T, Nortvedt MW, Carpentras G, Sotgiu MA, Sotgiu S, et al. Self-perceived physical functioning and health status among fully ambulatory multiple sclerosis patients. J Neurol. 2008; 255(2): 157-62.
36. Nortvedt MW, Riise T, Myhr KM, Nyland HI. Quality of life in multiple sclerosis: measuring the disease effects more broadly. Neurology. 1999; 22; 53(5): 1098-103.
37. Beckerman H, Kempen JC, Knol DL, Polman CH, Lankhorst GJ, de Groot V. The first 10 years with multiple sclerosis: the longitudinal course of daily functioning. J Rehabil Med. 2013; 45(1): 68-75.
38. Hoogervorst EL, Zwemmer JN, Jelles B, Polman CH, Uitdehaag BM. Multiple Sclerosis Impact Scale (MSIS-29): relation to established measures of impairment and disability. Mult Scler. 2004; 10(5): 569-74.
39. van der Linden FA, Kragt JJ, Klein M, van der Ploeg HM, Polman CH, Uitdehaag BM. Psychometric evaluation of the multiple sclerosis impact scale (MSIS-29) for proxy use. J Neurol Neurosurg Psychiatry. 2005; 76(12): 1677-81.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareMORPHOMETRIC ANALYSIS OF HUMAN CADAVERIC LUNGS
English3941Hina SharmaEnglish K. PrabhakaranEnglish L. K. JainEnglishIntroduction: Human lung, both right as well as left shows lot of variations in their length, breadth, thickness from person to person. Even the fissures and lobes in both the lungs show a variety of variations as shown by previous workers1-7. Apart from studying the variations of fissures and lobes in this study we have measured the length, breadth and thickness of both right and left Lungs and we have also measured the length and depth of transverse and oblique fissures of both the lungs right and left. Such measurements have not been done previously. Aims and objectives: To study the normal length, breadth and thickness of both, right and left lungs and also to study the variations in the length, breadth and thickness, of both right and left lungs and finally to study the normal fissures, lobes and their variations, of both right and left lungs. Materials and Methods: 13 Right and 14 left lungs obtained from embalmed cadavers, used for dissection in the Anatomy department, as a part of 1st year MBBS curriculum, of Geetanjali medical college and Hospital, Udaipur, formed the material for the current study.
Results: The left lung shows maximum variations of fissures in that they show an extra transverse fissure which is normally absent in the left lung. Out of 14 left lungs 5 of them that is 35.71%. Out of 14 left lungs 2 of them that is, 14.28% showed absence of oblique fissures. In case of right lungs out 13 only one of them that is, 7.69% showed absence of transverse fissures. Average measurements (length, breadth, thickness) of Right and left lungs have been measured.
EnglishLungs, Fissures, VariationsINTRODUCTION
Human lung, both right as well as left shows lot of variations in their length, breadth, thickness from person to person. Even the fissures and lobes in both the lungs show a variety of variations as shown by previous workers1-7 Apart from studying the variations of fissures and lobes in this study we have measured the length, breadth and thickness of both right and left Lungs and we have also measured the length and depth of transverse and oblique fissures of both the lungs right and left. Such measurements have not been done previously. Since surgeries on lung like lobectomy and other procedures like bronchoscopy, requires a thorough knowledge of normal measurements of lungs, their fissures and their variations , which prevents undue complications during surgery, this study was undertaken. Also a thorough knowledge of the variations helps us to understand the development of lungs including their molecular regulations better. Aims and objectives: 1. To study the normal length, breadth and thickness of both, right and left lungs. 2. To study the variations in the length, breadth and thickness, of both right left lungs. 3. To study the normal fissures, lobes and their variations, of both right and left lungs.
MATERIALS AND METHODS
13 Right and 14 left lungs obtained from embalmed cadavers, used for dissection in the Anatomy department, as a part of 1st year MBBS curriculum, of Geetanjali medical college and Hospital, Udaipur, formed the material for the current study Each lung was washed with water and carefully measured using a thread and flexible measuring tape (Fig1). Length, breadth, thickness of both right and left lungs were measured and recorded. So also the length of fissures (both horizontal and oblique fissures in case of right lung and oblique fissure in case of left lung), their depth were measured and recorded. Any unusual or rare variations were photographed using a digital camera (Fig 2). So obtained measurements were subjected to statistical analysis to obtain the mean values which would be of importance for cardiothoracic surgeons and pulmonologists.
Variations in the length, breadth and thickness:
The mean length (vertical) of right lung was 21.60 - + 4.13, the longest of them all measured 29.4cm and shortest measured 15cm (table no.1)
The mean breadth (transverse) of right lung was 8.96 - + 1.24, the broadest of them all measured 11.4cm and narrowest measured 7.3cm (table no.1) The mean thickness (Antero-posterior) of right lung was 15.3 - + 2.71, the thickest of them all measured 22.2cm and thinnest measured 10.6cm (table no.1) The mean length (vertical) of left lung was 21.28 - + 3.36, the longest of them all measured 25.9cm and shortest measured 15cm (table no.1) The mean breadth (transverse) of left lung was 7.20 - + 1.46, the broadest of them all measured 10cm and narrowest measured 5cm (table no.1) The mean thickness (Antero-posterior) of left lung was 11.50 - + 2.68, the thickest of them all measured 16.8cm and thinnest measured 7.5cm (table no.1)
Variations in the fissures and lobes:
5 left lungs showed transverse fissures (Fig 2), their details are given in table no.2 2 left lungs showed absence of oblique fissures. 1 right lung showed absence of transverse fissures. Measurements of fissures of both left and right lungs are given in table no.2 and table no.3
DISCUSSION
We have seen that the left lung shows maximum variations of fissures in that they show an extra transverse fissure which is normally absent in the left lung. Out of 14 left lungs, 5 of them that is 35.71% of left lung showed transverse fissures where as a previous study has shown only 8% 2 . Out of 14 left lungs, 2 of them that is 14.28%, showed absence of oblique fissures where as a previous study has shown only 3.6%1 .Yet another study showed only 10.7% 4 . In case of right lungs out 13, only one of them, that is 7.69% showed absence of transverse fissure where as previous studies have shown 18.7%1 and 7.1% 4 . Apart from studying the variations of fissures and lobes in this study we have measured the length, breadth and thickness of both right and left Lungs (table no. 1) and We have also measured the length and depth of transverse and oblique fissures of both the lungs right and left ( table no. 2 and 3). Such measurements have not been done previously. Knowledge of normal measurements of lungs, their fissures and their variations helps cardiothoracic surgeons to avoid undue complications during surgery. Also it helps radiologist to make accurate diagnosis in case of lung pathologies.
SUMMARY AND CONCLUSIONS
Average measurements (length, breadth, thickness) of Right and left lungs have been measured. Left lung and right lung show variations in their length, breadth and thickness. They also show variations in appearance (presence/absence) and measurements of fissures. Left lung shows maximum variations in both transverse and oblique fissures. Knowledge of normal measurements of lungs their fissures and their variations helps cardiothoracic surgeons to avoid undue complications during surgery. Also it helps radiologist to make accurate diagnosis in case of lung pathologies.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The Authors are also grateful to Authors/Editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=712http://ijcrr.com/article_html.php?did=7121. Murlimanju BV, Prabhu LV, Shilpa K, Pai MM, Kumar CG, Rai A, Prashanth KU. Pulmonary fissures and lobes: a cadaveric study with emphasis on surgical and radiological implications. Clin Ter. 2012; 163(1):9-13.
2. Hemanová Z, Ctvrtlík F, He?man M. Incomplete and accessory fissures of the lung evaluated by high-resolution computed tomography. Eur J Radiol. 2014 Mar;83(3):595-9
3. Sreenivasulu K, Anilkumar P, Gaiqwad MR. Morphological anatomy of accessory fissures in lungs. Indian J Tuberc. 2012 Jan;59(1):28-31.
4. Prakash, Bhardwaj AK, Shashirekha M, Suma HY, Krishna GG, Singh G. Lung morphology: a cadaver study in Indian population. Ital J Anat Embryol. 2010;115(3):235-40.
5. Ugalde P, Camargo Jde J, Deslauriers J. Lobes, fissures, and bronchopulmonary segments. Thorac Surg Clin. 2007 Nov;17(4):587-99.
6. Meenakshi S, Manjunath KY, Balasubramanyam V. Morphological variations of the lung fissures and lobes. Indian J Chest Dis Allied Sci. 2004 Jul-Sep;46(3):179-82.
7. Aldur MM, Denk CC, Celik HH, Tasçioglu AB. An accessory fissure in the lower lobe of the right lung. Morphologie. 1997 Mar;81(252):5-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareEVALUATING THE LEVEL OF ANXIETY AMONG PRE-OPERATIVE PATIENTS BEFORE ELECTIVE SURGERY AT SELECTED HOSPITALS IN KINGDOM OF SAUDI ARABIA
English4246Priya GangadharanEnglish Reemas Ali Mohemed AssiriEnglish Feddah Ahemed Ali AssiriEnglishBackground: Patients who undergo surgery usually experience an intense level of anxiety in the pre-operative period. The objective of the study was to assess various levels of anxiety and find out its association with selected demographic variables. Methods: A Descriptive study was performed with 20 inpatients scheduled for elective surgery. Age ranged from 20 to 60 years. Demographic information was collected using a structured questionnaire. The measuring instrument to assess the patient’s anxiety was State- Trait Anxiety Inventory (STAI).
Results: Among the pre operative patients , majo rity had High anxiety ( 60%), 30% of them had moderate and only 10% had low anxiety before surgery. There was no difference in state and trait anxiety among patients. Women (45%) had higher baseline state and trait anxiety than men(15%). Selected demographic variables were associated with anxiety levels and found that marital status had significant association with various levels of anxiety (p< 0.05).
Conclusion: The STAI is a useful instrument to assess the level of patients’ preoperative anxiety and the need for information. Measuring anxiety before any surgery helps the patient to alleviate their worries to some extent with the support of health care professionals.
EnglishAnxiety; Pre-operative patients; Elective surgery; Level of AnxietyINTRODUCTION
Many patients experience substantial anxiety before operation and this is reported to affect 60–80% of surgical patients. Anxiety also increases the requirement of anesthetic drugs to produce unconsciousness and therefore may indirectly increase the risk of awareness. This feeling remains common today despite advances in medicine and surgical techniques. It is the responsibility of healthcare professionals to ensure that any patient undergoing an elective surgical procedure is both physically and psychologically prepared. However, with increasing demands on the health service to be more efficient, little time is set aside to meet the psychological needs of the surgical patient. Anxiety may also worsen patients’ perception of pain and increase requirements for postoperative analgesia. Anxiety may decrease patients’ overall satisfaction with peri operative care. Reducing preoperative anxiety may improve surgical outcome, shorten hospital stay, and minimize lifestyle disruption.(1) Since the early days of surgery patients have been anxious about undergoing operations. This feeling remains common today despite advances in medicine and surgical techniques. It is the responsibility of healthcare professionals to ensure that any patient undergoing an elective surgical procedure is both physically and psychologically prepared.(2). Patients coming into hospital can suffer a great deal of anxiety who undergo surgery experience acute psychological distress in the pre-operative period. These fears manifest themselves as uncertainty, loss of control and decreased self-esteem, anticipation of postoperative pain, and fear of separation from family (3).
An aversive hospital environment may increase anxiety and negatively influence health outcomes also increased preoperative anxiety is associated with poor postoperative behavioral and clinical recovery. Some degree of anxiety is a natural reaction to the unpredictable and potentially threatening circumstances typical of the preoperative period, especially for the patient’s first few surgical experiences. (8) and (20). High levels of pre- operative anxiety have un favorable effects on induction and maintenance of anesthesia as well as on the recovery from anesthesia and surgery. (9) Surgery is commonly regarded as a psychologically stressful experience that requires appraisal and coping responses. Stress occurs when a situation has appraised as demanding and as having the potential to exceed coping resources. (10) Objectives: • To assess various levels of anxiety among pre-operative patients. • To find out the association between anxiety and the selected demographic variables.
Study Design:
Descriptive Design was adopted for the study. Hypotheses:
1. Patients who undergo any surgical procedure may have increased level of anxiety
2. There may be significant association between level of anxiety and selected demographic variables.
MATERIALS AND METHODS
Designs and settings: The research design used for the study was Descriptive design. The setting consisted of the male and female preoperative wards of Muhyl General Hospital, Regal Alma, and Magarda Ministry Hospitals. The study was conducted from 14th March 2013 to 15th April 2013. Samples: The samples were selected by using Convenient sampling technique. Patient who had history of Psychiatric disorders and Neurological problems were excluded. The total number of samples were 20. Patients age ranged between 20 and 60 years. The proportion of the Male and female samples were 40% and 60% respectively. Majority (80%) of the samples were married and 65% of them had previous surgical history. Instruments: 1. Tool I: This tool consists of background information of patients on selected items include Age, sex, marital status and previous history of surgery. 2. Tool II: State Trait anxiety inventory (STAI) The STAI-state (STAI-S) form consists of 20 statements, and the answers to these are used to determine a patient’s current anxiety level; the STAI-trait (STAI-T) form consists of a different set of 20 statements, and the answers to these are used to determine a patient’s underlying anxiety level. Each statement in the STAI-S is rated on a four-point scale for the subject’s agreement with that statement (not at all, somewhat, moderately so, and very much so). Statements in the STAI-T are also rated on a four-point scale (almost never, sometimes, often, and almost always). This form was used for each participant on entering the study . The overall (total) score for STAI ranges from a minimum of 20 to a maximum of 80; STAI scores are commonly classified as ‘no or low anxiety’ (20–37), ‘moderate anxiety’ (38–44), and ‘high anxiety’ (45–80) (H. A. Jlala, et al ). Ethical Considerations and Human Rights The Research proposal was approved by the ethics committee of the College and hospital authorities. Patients were well informed about the purpose of this research and their rights to withdraw or refuse at any time during the study period. Also ensured them about the confidentiality of the obtained information. Statistical Analysis The data gathered through different techniques has been compiled by adopting suitable statistical methods. After categorization, the data frequencies were computed for demographic variables to decide the distribution prototype of patients into each level.. Similarly frequencies were calculated for level of anxiety among the patients. The distribution pattern is depicted through appropriate graphical methods. The results are inferred through statistical techniques like Descriptive and Inferential Statistical methods like Mean, SD and ‘Chi’-square test ( used to find out the association between anxiety and selected demographic variables like age, sex, marital status and past history of surgery). Results Table 1 presents ,the pre - operative patient’s anxiety levels and its associations with selected demographic variables such as age, sex, marital status and patients history of previous surgeries were measured and the findings drawn accordingly. The data mentioned in Table 2 shows that, a high level of anxiety was found in married patients (55%) while the single status presented a similar level of high and moderate anxiety (5%). Also the moderate anxiety among married patients were 25% but none of them had low anxiety. But 10% of unmarried patients showed low level of anxiety. Data shows statistically significant association between level of anxiety and Marital status (p = 0.011). As shown in Table 3, among the 20 pre-operative patients, majority of patients (35%) underwent surgery for Hernia , 30% had Gastro intestinal surgery while orthopedic and Hepato- biliary surgeries were 20% and 15% respectively. There was no difference in state and trait anxiety among patients. Women (45%) had higher baseline state and trait anxiety than men (15%). Regarding the level of anxiety among the patients , majority had High anxiety ( 60%), 30% of them had moderate and only 10% had low anxiety before surgery (Fig.1) The prevalence of high anxiety in the age group 20- 29 years was 20% while only 10% had low anxiety. In the age group 30-39 years, the high and moderate anxiety were equal (15%).The high and moderate anxiety among the age group of 40 -50 years were 20% and 15% respectively. None of the patient belongs to the age group of 50-59 years had moderate and level of low anxiety while 5% of them had high level of anxiety (Fig 2 ). Discussion Operations can restore health and even save life, but it is normal to feel a bit anxious about “going under the knife”, especially the day or two beforehand, which are often spent in the hospital preparing for the operation. (6) Anxiety may cause physical symptoms such as a pounding or racing heart, an irregular pulse, nausea and sleeplessness. These symptoms can sometimes end up causing more anxiety, because they may be wrongly interpreted as a sign that the illness is getting worse.(7) Preoperative anxiety is a common phenomenon among indoor surgical patients. A lot can be done to alleviate this anxiety by improving doctor-patient communication. Better doctor-patient communication which involves information sharing about the surgical procedure, patient satisfaction, attention to queries by the patient and trust in the physician was associated with lower anxiety levels. (10) Change of environment, waiting time of surgery, postoperative pain, fear of one’s life, nil per mouth, blood transfusion, fear of unknown, getting stuck with needles and awareness during surgery were the significant factors responsible for increase preoperative anxiety in women as compared to males.(12) Effective communication is the cornerstone of good healthcare yet it can be a difficult skill to master. Poor communication can have serious consequences for patients and cause irreparable damage to the nurse-patient relationship. Nurses can use communication skills to help reassure patients before surgery.(17) The present study examines the various levels of anxiety among patients before surgery and its association on some of the selected variables. The prevalence of high anxiety in the age group 20- 29 years was 20% while only 10% had low anxiety. In the age group 30-39 years, the high and moderate anxiety were equal (15%).The high and moderate anxiety among the age group of 40 -50 years were 20% and 15% respectively. The patient belong to the age group of 50- 59 years lacks moderate and low anxiety while only 5% had high anxiety. Among the pre operative patients , majority (60%) had High anxiety,30% of them had moderate and only 10% had low anxiety before surgery. There were limitations in the present study: i. More research can be conducted on specific interventions to reduce pre operative anxiety and assess its effectiveness post operatively. ii. Sample size of the present study is limited to 20. iii. In this research we administered one measurement scale ie, STAI , and it would be better if applied more instruments to determine the accurate scale.
CONCLUSION
The present research investigated various types of anxieties a patient would undergo before any surgical procedure. The study highlighted the association between anxiety and selected demographic variables. More research is required to find out the specific strategies or interventions to alleviate anxiety before surgery.
ACKNOWLEDGEMENT
Authors would like to express their gratitude towards Department of Nursing,College of Applied Medical Sciences, King Khalid university, Mohyl and Hospital management for their constant support encouragement for the successful completion of the study and utilizing the facilities. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. They are also thankful to the subjects of this study for their valuable participation. Authors also grateful to IJCRR editorial team and reviewers to bring quality of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=713http://ijcrr.com/article_html.php?did=7131. Pritchard M. Measuring anxiety in surgical patients using a visual analogue scale. Nurs Stan 2010 Nov 17; 25 (11): 40-4
2. Vadla D, Bozikov J, Blazekovi?-Milakovi? S, Kovaci? L. Anxiety and depression in elderly-prevalence and association with health care. LLijec Vjesn. 2013 MayJun;135(5-6):134-8.
3. Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics.2006 Aug;118(2):651-8.
4. Laufenberg Feldmann R, Kappis B Assessing preoperative anxiety using a questionnaire and clinical rating: A prospective observational study. Eur J Anaesthesiol.2013 Dec; 30(12):758-63.
5. Timothy M. Osborn and Noah A. Sandler. The effect of anxiety on intravenous sedation Anesth Prog 2004;51(2): 46–51
6. Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety before elective surgery. Neurosciences 2007;12 (2).
7. L. Ebirim, M Tobin, Factors responsible for Pre-operative anxiety in Elective surgical patients at a university teaching hospital : A pilot study. The internet journal of Anesthesiology 2010; 29 (2).
8. Marsha L. Harbin. A comparative study of the effects of environment on preoperative anxiety and pain level and postoperative outcomes of an outpatient population. Dissertation Abstracts International 2007 ; 67-11: 6298.
9. Wang SM , Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth Analg 2002 Jun;94(6):1489-94
10. Vandana B. Nikumb, Amitav Banerjee, Gurleen Kaur, and Suprakash Chaudhury. Impact of doctor-patient communication on preoperative anxiety: Study at industrial township. Ind Psychiatry J. 2009 Jan-Jun; 18(1): 19–21.
11. Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Int J Nurs Stud 2012 Feb; 49(2) :129-37.
12. Zubia Masood, Jahanzaib Haider, Masood Jawaid, Shams Nadeem Alam. Preoperative anxiety in female patients: The issue needs to be addressed. KUST Med J 2009; 1(2): 38-41
13. Wetsch WA, Pircher I, Lederer W, Kinzl JF, Traweger C, Heinz-Erian P, Benzer A.Preoperative stress and anxiety in day-care patients and in patients undergoing fast-track surgery. Br J Anaesth 2009 Aug;103(2):199-205.
14. Pritchard MJ. Managing anxiety in the elective surgical patient. Br J Nurs 2009 Apr;18(7):416-9.
15. Alvisa Palese, Marta Cecconi, Renzo Moreale and Miran Skrap. Pre-operative Stress, Anxiety, Depression and Coping Strategies Adopted by Patients Experiencing Their First or Recurrent Brain Neoplasm: An Explorative Study. Stress and Health. 2012 Nov;28(5) :416–425.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21HealthcareANAGEN EFFLUVIUM - A REVIEW
English4749ShashikantEnglish Nagaraj MallashettyEnglishAnagen effluvium is a type of hair loss that follows the administration of chemotherapeutic drugs, radiation treatment and various chemical agents. It is characterized by hair breakage rather than hair loss. Hair shafts break at about the same time when the thin portion reaches the scalp surface. The hair loss in anagen effluvium is quite disturbing to patients and their family members. Dermatologists have little experience with anagen effluvium.
EnglishAnagen effluvium, Diffuse hair lossINTRODUCTION
Anagen effluvium (AE) is a type of diffuse hair loss that follows the administration of cytotoxic drugs, radiation treatment or various chemical agents and is characterized by hair breakage rather than hair loss.1 Anagen effluvium has an estimated incidence of 65% and is considered to be one of the most traumatic aspects of chemotherapy in female patients.2a Hair shafts break at about the same time when the thin portion reaches the scalp surface. Anagen effluvium can be managed with various drugs, even if anagen effluvium cannot be prevented.1
ETIOPATHOGENESIS
Anagen effluvium occurs during the anagen phase of growth because hair bulb cell divide rapidly and are sensitive to cytotoxic agents. Cytotoxic drugs impair the mitotic and metabolic processes in actively growing hair follicles, leading to thinning of the shaft, which becomes fragile and susceptible to fracture with minimal trauma. The molecular mechanism of AE has been associated with premature apoptosis-driven hair follicle regression, and p53, Fas and c-kit are the involved factors.1These agents can impair or totally disrupt the anagen cycle and cause varying degree of hair follicle dystrophy. The net result is either anagen hair that break off within the hair follicle or at the level of scalp (secondary to a weak point in the structurally inferior hair shaft) and are then shed without roots, or dystrophic anagen hair that are easily dislodged from the usual follicular moorings.3 Various causes of anagen effluvium has been presented in table 1.
CLINICAL FEATURES
Anagen effluvium is typically reversible. Severity of hair loss depends on the route of administration as well as the dose and frequency of administration. Hair shedding usually begins at 1-3 weeks after initiation of chemotherapy and becomes most clinically apparent in 1-2 months.
It most commonly affects scalp hair due to long anagen phase and to a variable degree terminal hair at other sites such as eyebrows, eyelashes, axillary and pubic hair.7 The World Health Organization criteria for alopecia is grade 0 = no loss, grade 1 = mild hair loss, grade 2 = moderate hair loss grade 3= reversible complete hair loss and grade 4 = irreversible complete hair loss.8 A careful history is an important key to identify triggers in any patient with diffuse hair loss.9 Anagen effluvium is a reversible condition, and hair regrowth begins several weeks after the cessation of chemotherapy. Hair loss is known to start from the area of mechanical friction such as crown and side of the head above the ears because these areas come in contact with bed linens, pillow and head covering. Nearly 85% of the total number of anagen hair are shed after chemotherapy and scalp hair those are in the telogen phase are not affected (figure 1).1 When hair regrows, approximately 65% of the patients experience a change from their previous hair. Some patients experience alteration in the colour, texture or type of hair.1 Regrowth of hair after radiation therapy depends upon type, depth, and dose-fractionation but it commonly leads to permanent follicular destruction, most likely as a result of irreversible hair follicle stem cell damage leading to scarring alopecia. In fact, this scarring alopecia may progress long after radiation therapy has been discontinued; possibly due to persistent radiation-induced inflammatory changes that progressively damage hair follicle stem cells. Low dose cytotoxic agents more often cause only telogen effluvium, because they induce premature catagen. High dose busulfan which is used in the preparatory treatment for bone marrow transplantation may lead to permanent alopecia due to irreversible damage to hair follicle stem cells.3 In a study by Korean author Jung Yun S, 20 among the 38 female patients of anagen effluvium had patterned hair loss. They did not notice any significant difference in the pattern of hair loss depending upon age, associated symptoms and chemotherapeutic agent groups.1 Hair loss resembling androgenetic alopecia and changes in the structure and colour have been reported with tamoxifen therapy.10
INVESTIGATIONS
Clinically diffuse hair loss can be diagnosed by hair pull test.11 The hair pull test is positive in anagen effluvium. Light microscopic examination shows dystrophic anagen hair (figure 2) with tapered ends and thinning or constriction of the hair shafts called Pohl-Pinkus constriction.9, 10
TREATMENT
If the insult ceases, growth of hair restarts within weeks.9 Various measures have been tried in order to prevent hair loss. Topical minoxidil has been found to decrease the duration of hair loss caused by chemotherapy. Minoxidil is not effective in preventing initial hair loss due to chemotherapeutic agents. It should not be used in patients undergoing chemotherapy for hematological malignancies with a curative intent.7 Scalp cooling has been reported as an effective method of preventing chemotherapy-induced alopecia.4 It involves cooling of the scalp with cold air or liquid. It produces vasoconstriction of the scalp vessels leading to reduced blood flow to the follicles during chemotherapy thus minimizing concentration of the antineoplastic agent in plasma.7 However it may not be effective when multiple drug regimes or very high doses of individual drugs are used. There are no specific guidelines on optimal method, temperature, and duration of scalp cooling at present.7
CONCLUSION
Anagen effluvium is one of the causes of diffuse hair loss. Severity of the hair loss depends on the route as well as dose and frequency of administration of chemotherapeutic drugs which is typically reversible.
ABBREVIATION
AE – Anagen effluvium
ACKNOWLEDGEMENT
We acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=714http://ijcrr.com/article_html.php?did=7141. Yun SJ, Kim SJ. Hair loss pattern due to chemotherapyinduced anagen effluvium: a cross-sectional observation. Dermatology 2007;215:36-40.
2. Trüeb R. Chemotherapy-induced Hair Loss. Skin Therapy Lett 2010;15:5-7.
3. Paus R, Olsen EA, Messenger AG. Hair growth disorders. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, editors. Fitzpatrick’s dermatology in general medicine, 7thedn. NewYork: McGraw Hill; 2008.p.- 753-778.
4. Chadha V, Shenoi SD. Hair loss in cancer chemotherapeutic patients. Indian J Dermatol Venereol Leprol 2003;69:131- 132.
5. Habif TP. Hair diseases. In: Habif TP, editor. Clinical dermatology: A color guide to diagnosis and therapy, 3rd edn. St. Louis: Mosby; 1996.p.- 739-747.
6. Wadhwa SL, Khopkar U, Nischal KC. Hair and scalp disorders. In: Valia RG, Valia AR, editors. IADVL Text book of dermatology, 3rd edn. Mumbai: Bhalani Publishing House; 2010.p.- 864-948.
7. Atanaskova Mesinkovska N, Bergfeld WF. Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment. Dermatol Clin 2013;31:119- 127.
8. Protière C et al. Efficacy and tolerance of a scalp-cooling system for prevention of hair loss and the experience of breast cancer patients treated by adjuvant chemotherapy. Support Care Cancer. 2002;10:529-37.
9. Harrison S, Bergfeld W. Diffuse hair loss: its triggers and management. Cleve Clin J Med 2009;76:361-367.
10. Lindner J et al. Hair shaft abnormalities after chemotherapy and tamoxifen therapy in patients with breast cancer evaluated by optical coherence tomography. Br J Dermatol 2012;167:1272-1278.
11. Rustom A, Pasricha JS. Causes of diffuse alopecia in women. Indian J Dermatol Venereol Leprol 1994;60:266-271.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241622EnglishN2014November21General SciencesGROWING STOCK OF VARIOUS PURE CONIFER FOREST TYPES OF CENTRAL (GARHWAL) HIMALAYA, INDIA
English5054Suchita DimriEnglish Pratibha BaluniEnglish Chandra Mohan SharmaEnglishObjective: The Conifers forests cover an extensive area in Uttarakhand and provide variety of ecosystem services. The Present study was intended with an aim to assess the growing stock potential of the pure coniferous forest of Garhwal Himalaya. Methods: Five sample-plots of 0.1 ha were randomly laid out at five different sites in each forest type to estimate the Growing Stock Volume Density (GSVD) using appropriate volume tables and volume equations. Results and Conclusion: Abies pindrow forest was observed to possess the highest growing stock (988.3 m3/ha) followed by Cupressus torulosa (922.3 m3/ha). It is observed that conifers forests possess high stand volume and long rotation period hence promising as carbon sink therefore should be recommended for plantation silviculture alongwith special conservation protection to mature forests.
EnglishGrowing stock, Rotation period, Conifers, Standing volumeINTRODUCTION
The terrestrial vegetation plays an important role within the global carbon cycle and hence the earth system, as it sequesters atmospheric carbon dioxide and is thus able to mitigate global warming (Bonan, 2008). Biomass dynamics reflect the potential of vegetation to act as a carbon sink over the long term, as they integrate photosynthesis, autotrophic respiration and litter fall fluxes. The tons of forest biomass per unit volume of growing stock (GS) energize the ecosystems and can fuel economies (Kauppi et al., 2006). Forest biomass assessment for large areas across the globe are based on three main approaches: estimating using mean biomass densities (Ajtay, 1979); using field inventory of GS and biomass expansion factors (Lal and Singh, 2000) and spatial modelling approach in geographic information system using spatial databases of physiography, climatic, soil and forest distribution and models of biomass productivity (Iverson et al., 1994). Many factors act to alter forest biomass, including selective wood harvest, forest fragmentation, ground fires, shifting cultivation, browsing, grazing and accumulations of biomass in growing and recovering (or secondary) forests (Houghton, 2005) .The estimation of increment and felling of Standing volume has therefore assumed crucial, significance in estimating climate change. The growing stock(GS) volume, a key parameter in the context of forest resource management and global change issues, also referred to as stem volume or bole volume of living trees, represents the volume of the tree stems (including bark but excluding branches and stumps) for all living species per unit area (Santoro et al., 2011). The inter annual variability of carbon fluxes remains relatively unexplored (Wolf et al.,2011) mainly due to the absence of consistent spatial information on biomass (Bellassen et al., 2011). The Growing Stock Volume Density (GSVD) is a major predictor for assessing the above-ground biomass (Shvidenko et al., 2007) and is central for estimating compartment (Jenkins et al., 2003) or total above-ground biomass (Somogyi et al., 2008), which is a elementary variable for assessing the net carbon dioxide exchange between the land surface and the atmosphere. In Garhwal Himalaya conifers are main forest forming species which constitute about 1/3rd of total forested area and provide variety of ecosystem services. Conifers form a distinct group, which has become very important in world economy, because they grow fast on poor soil even under harsh climate and yield timber that is suitable for industries. Growing stock inventory is being done by the forest department but not species wise for pure forest types. The present study was therefore aimed to know the growing stock variation in the pure coniferous forest types of Garhwal Himalaya of Uttarakhand, India.The information on forest volume from forest inventory can provide us valuable information about stand biomass and carbon flux.
MATERIAL AND METHODS
Growing stock Estimation: General survey of the study area was carried out to identify and earmark different pure coniferous forest type’s viz., Abies pindrow, Cedrus deodara, Cupressus torulosa, Picea smithiana, Pinus roxburghii, in different forest types of Garhwal. For quantitative analysis of forest vegetation, five sample plots of 0.1ha each were randomly laid out in each forest type (05 sample plots×05 forest types =25 plots). The volume of individual tree species for various sample plots was calculated on the basis of existing standard volume table or equations (FSI, 1996) given in Table 1. The volumetric estimation of the tree species have been done on the basis of standard volume tables/equations based on the Indian forest records, F.R.I., and F.S.I. publications of the respective species.
Study Area:
The state is located in North-West part of the country. Uttarakhand’s geographical area is 53,483 square km which constitutes 1.63% of the country’s total area (FSI, 2011). Garhwal Himalaya, which is situated in western part of the Central Himalaya encompasses biodiversity rich forests and is located between the latitudes 300 00.993’ to 300 03.764’ N and longitudes 790 9.724’ to 790 12.040’ E. The study area ranged from 1200-3100 m asl of altitude experiencing temperate type of climate with moderate to high snowfall from December to February. The precipitation effectiveness increases with elevation because of temperature and sunshine decline (Muller, 1982). The mean annual rainfall and snowfall in the study area ranged between 2731mm and 23 inches (at 1200 m asl) to 1745 mm and 170 inches (at 3100 m asl). The rainy season accounts for about three-quarters of the annual rainfall. Mean minimum monthly temperature ranged between 8o C (Jan) to 20.65o C (Jun) at 1200 asl and 2.68o C (Jan) to 9.30o C (Jun) at 3100 m asl. Whereas, maximum monthly temperature ranged between 20.0o C to 30.15o C at 1500 m asl and 7.45o C to 18.73o C at 3100 m asl. The soil type was basically brown- black forest soils and podozolic soils (Valdiya, 1980; Gairola, 2010).
RESULTS
The allocation of the standing volume in all five conifer forest types is shown in Table 2. Among all the conifer forest types studied Abies pindrow was observed to be possessing the maximum growing stock that is 988.3 m3 / ha followed by Cupressus torulosa that is 922.3 m3 /ha (Figure1). The maximum growing stock for Abies pindrow forest type was 1174.4m3 /ha recorded in Site IV, followed by1099.9 m3 /ha for Site V. The growing stock in Cedrus deodara forest cover type oscillated between 501.1 m3 /ha to 913.3 m3 /ha. For Cupressus torulosa forest cover type the highest GSVD 1834.6 m3 /ha was estimated in Site II. The growing stock in Picea smithiana and Pinus roxburghii forest cover type oscillated between 268.7 m3 /ha to 804.3 m3 /ha and 297.4 m3 /ha to 925.6 m3 /ha.
DISCUSSION
The estimation of stem volume and tree biomass is needed for both sustainable planning of forest resources and for studies on the energy and nutrients flows in ecosystems (Zianis et al., 2005). Walle et al., 2005 reviewed the potential role of biomass as an energy source and carbon stocks in the 21st century. The total growing stock of wood in India is estimated to be 6,098.23 million m3 compromising 4,498.66 million m3 inside forested area and 1599.57 million m3 outside recorded forest area (FSI, 2009).The total growing stock of forests of Uttarakhand is 481.006 million m3 (FSI, 2011). The growing stock values in the present study for various forest type was recorded as 998.30m3 /ha in Abies pindrow,922.2 m3 /ha in Cupressus torulosa, 755.8 m3 /ha in Cedrus deodara, 681.6 m3 /ha in Pinus roxburgii, 515.6 m3 /ha in Picea smithiana. Baduni (1996) has recorded values of growing for Abies pindrow as 239.66-389.95 m3 /ha in Pauri Garhwal whereas Gairola (2010) reported 272.87 m3 /ha for Mandal-Chopta forest. The higher volume in the present study is attributed to the more number of trees present in higher diameter classes and selection of less disturbed areas for study. Sharma et al. (2000) studied that there was the variation in growing stock of high Himalayan and Shiwalik Chir pine in different aspects and recorded maximum growing stock as 440 m3 /ha. The current need to assess changes in the forest carbon has arisen as a result of the Climate Convention and the Kyoto Protocol. Forest cover and forest structure provide additional important feedbacks on biophysical properties and processes like albedo and evapo-transpiration (Bonan, 2008). Thus, improving our knowledge about the state of the world’s forests is also important for understanding their influence on energy and water fluxes. Certain qualitative and quantitative parameters of the forest inventory such a tree diameter merchantable height of trees which are important for volume calculations cannot be measured for satellite imagery (Mahto, 2001). It is noted that satellite imageries obtained by remote sensing can only complement or improve and reduce field work but cannot replace it (Chaturvedi and Khanna, 1982).
The growing stock of a managed forest is lower than the growing stock of pristine forests due to application of thinning and clear cut management. The old and mature growth forests have high stand volume. During the ages from100 to 400 years, spruce forests have a high growing stock which will lead to higher average values in unmanaged forests (Kindermann et al., 2008). The significance of forest area is not sole indicator of forest development but growing stock and carbon storage can be considered equally important parameters (FAO, 2005). Stem volume does not determine the biomass of the foliage and roots, but it certainly has several build-in factors that affect the biomass of the tree components (e.g. water and nutrient supply, fertility, competition, moisture and length of growing season) (Makela et al., 1995).
CONCLUSIONS
Forests are the largest carbon pool on earth. They act as a major source and sinks of carbon in nature. Hence they have huge potential to form a chief component in the mitigation of global warming and adaptation to climate change. Estimation of the forest growing stock will enable us to assess the extent of loss of forest cover due to deforestation. The present study can form a basis for management, planning and decision making as forests are source of timber and NTFPs (FSI, 2011). As our study reports that Himalayan conifers have high growing stock potential it can be recommended for plantation silviculture hence playing a major role in curbing Global carbon emission.
ACKNOWLEDGEMENTS
Authors are thankful to University Grant Commission (UGC), New Delhi for providing financial support in form of research scholarship. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed
CONFLICT OF INTERESTS The authors declare no conflict of interest.
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